Abstract
ADVanced Organ Support (ADVOS) is a novel type of extracorporeal albumin dialysis and holds promise to sustain liver function and recovery of patients with acute-on-chronic liver failure (ACLF). Previously, ADVOS was tested as continuous treatment for intensive care patients with liver failure. Data related to the applicability and safety as discontinuous treatment outside of ICU is not available. Evaluation of ADVOS as discontinuous treatment for patients with ACLF outside intensive care unit and comparison with a matched historic cohort. In this retrospective study, 26 patients with ACLF and the indication for renal replacement therapy related to HRS-AKI were included. Majority of patients were male (65%) with alcoholic cirrhosis in 88% and infections as a trigger of ACLF in 96%. Liver function was severely compromised reflected by high median MELD and CLIF-C ACLF scores of 37 (IQR 32;40) and 56.5 (IQR 51;60), respectively. Patients were treated discontinuously with ADVOS over a median time of 12 days (IQR 8.25;17) and received 8 (IQR 4.25;9.75) treatment cycles on average. No treatment related adverse events were recorded, and safety laboratory parameters remained constant during the observation time. After 16 h cumulative dialysis therapy, ADVOS significantly reduced protein-bound bilirubin (14%), creatinine (11.8%) and blood urea nitrogen (BUN, 33%). Using a matched cohort with ACLF treated with hemodialysis, ADVOS achieved a stronger decrease in bilirubin (p = 0.01), while detoxification of water-soluble catabolites' including creatinine and BUN was comparable. The 28-days mortality in the ADVOS group was 56% (14/26) and was not inferior to predicted survival (predicted median 28-days mortality was 44%, IQR 30; 59). Discontinuous ADVOS treatment was safe and effective in patients with ACLF outside intensive care and outperformed hemodialysis in reducing protein-bound metabolites.
Highlights
Acute-on-chronic liver failure (ACLF) is a life-threatening condition which might occur in patients with liver cirrhosis
26 patients with acute-on-chronic liver failure (ACLF) who received ADVanced Organ Support (ADVOS) treatment were retrospectively studied between 06/2018 and 11/2020 (Table 2). 65.3% of patients were male with a median age of 53.5 years (IQR 49; 57.75)
All patients were diagnosed with ACLF with a median CLIF-C ACLF score of 56.5 (IQR 51;60), having the indication for renal replacement therapy based on critical laboratory parameters or fluid overload due to Hepatorenal syndrome-acute kidney injury (HRS-acute kidney injury (AKI)) (100%) [5, 14]
Summary
Acute-on-chronic liver failure (ACLF) is a life-threatening condition which might occur in patients with liver cirrhosis. According to the European Association for the Study of the LiverChronic Liver Failure (EASL-CLIF) Consortium ACLF is characterized by an acute decompensation of the cirrhotic liver and includes organ failure and high short-term mortality. The European Association for the Study of the Liver Chronic Liver Failure (EASL-CLIF) consortium set up the CANONIC (EASL-CLIF ACLF in Cirrhosis) study and developed the CLIF-C ACLF score to stratify patients with ACLF and predict 28-days mortality [5, 6]. ADVanced Organ Support (ADVOS) is a novel type of extracorporeal albumin dialysis and holds promise to sustain liver function and recovery of patients with acute-on-chronic liver failure (ACLF). Data related to the applicability and safety as discontinuous treatment outside of ICU is not available
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