Liver-Support Therapies in Critical Illness-A Comparative Analysis of Procedural Characteristics and Safety

Extracorporeal liver-support therapies remain controversial in critically ill patients, as most studies have failed to show an improvement in outcomes. However, heterogeneous timing and inclusion criteria, an insufficient number of treatments, and the lack of a situation-dependent selection of avail...

Full description

Saved in:
Bibliographic Details
Published in:Journal of clinical medicine 2023-07, Vol.12 (14), p.4669
Main Authors: Göth, Daniel, Mahler, Christoph F, Kälble, Florian, Speer, Claudius, Benning, Louise, Schmitt, Felix C F, Dietrich, Maximilian, Krautkrämer, Ellen, Zeier, Martin, Merle, Uta, Morath, Christian, Fiedler, Mascha O, Weigand, Markus A, Nusshag, Christian
Format: Article
Language:English
Subjects:
Anticoagulants
Care and treatment
Clinical medicine
Comparative analysis
Health aspects
Hepatitis
Hypoxia
Intensive care
Ischemia
Laboratories
Liver
Liver diseases
Medical equipment
Medical research
Medical technology
Medicine, Experimental
Mortality
Patients
Plasma exchange (Therapeutics)
Protein binding
Proteins
Renal replacement therapy
Safety and security measures
Sepsis
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Extracorporeal liver-support therapies remain controversial in critically ill patients, as most studies have failed to show an improvement in outcomes. However, heterogeneous timing and inclusion criteria, an insufficient number of treatments, and the lack of a situation-dependent selection of available liver-support modalities may have contributed to negative study results. We retrospectively investigated the procedural characteristics and safety of the three liver-support therapies CytoSorb, Molecular Adsorbent Recirculating System (MARS) and therapeutic plasma exchange (TPE). Whereas TPE had its strengths in a shorter treatment duration, in clearing larger molecules, affecting platelet numbers less, and improving systemic coagulation and hemodynamics, CytoSorb and MARS were associated with a superior reduction in particularly small protein-bound and water-soluble substances. The clearance magnitude was concentration-dependent for all three therapies, but additionally related to the molecular weight for CytoSorb and MARS therapy. Severe complications did not appear. In conclusion, a better characterization of disease-driving as well as beneficial molecules in critically ill patients with acute liver dysfunction is crucial to improve the use of liver-support therapy in critically ill patients. TPE may be beneficial in patients at high risk for bleeding complications and impaired liver synthesis and hemodynamics, while CytoSorb and MARS may be considered for patients in whom the elimination of smaller toxic compounds is a primary objective.
ISSN:2077-0383
2077-0383
DOI:10.3390/jcm12144669