Abstract
The mortality of patients with hepatic failure remains high. Often the patient's life can be saved only with extracorporeal liver support (ELS). ELS systems – MARS® и Prometheus® have proved their efficacy but their widespread use is constrained by their very high cost. Introduction in clinical practice of new affordable ELS systems is a topical issue. The objective: to compare clinical and laboratory effects of selective plasma exchange (SPE), plasmadialfiltration (PDF) with use of the selective membrane plasma separators EvaclioTM and MARS® and Prometheus® (FPSA) systems in the treatment of liver failure. Subjects and methods: 15 extracorporeal procedures of each type were performed in 52 patients with acute liver failure (14) and acute-on-chronic liver failure (38): MARS, FPSA, PDF, SPE with use of Evaclio ЕС-2C, and ЕС-3C, ЕС-4C. The clinical and laboratory parameters (total, direct and indirect bilirubin, total protein, albumin, creatinine, urea, etc.), severity of the condition according to MELD score were determined before and after the session and the next morning. Changes, side effects and complications of procedures were assessed and compared. Results. Reduction of concentration of direct bilirubin was comparable with FPSA, PDF and SPE on Evaclio ЕС-3C20 и ЕС-4C20 (38-42%), indirect bilirubin – with PDF and SPE on Evaclio ЕС-3C20 и ЕС-4C20 (29-34%). Low-molecular metabolites (urea, creatinine) were better removed with FPSA (35-44%) and PDF (40-42%). The reduction of their concentration with SPE was insignificant. The reduction of albumin level was the highest with FPSA (10.2%) and SPE on Evaclio ЕС-4C20 (14.3%). All investigated ELS methods did not exert a significant influence on the basic parameters of blood coagulation and quantity of blood cells. No side effects and complications were observed. Conclusion: Selective plasma exchange and plasmadiafiltration are generally comparable in clinical and laboratory effects in the treatment of liver failure with MARS and Prometheus system provided significantly lower costs.
Highlights
Вестник анестезиологии и реаниматологии, Том 17, No 3, 2020 with FPSA (10.2%) and SPE on Evaclio ЕС-4C20 (14.3%)
All investigated ELS methods did not exert a significant influence on the basic parameters of blood coagulation and quantity
При изолированной гипербилирубинемии предпочтение может быть отдано СПФ с использованием фракционатора Evaclio ЕС-3C20, при выраженном дефиците факторов свертывания, при необходимости дополнительного удаления низкомолекулярных веществ (аммиак, мочевина креатинин) у пациентов с печеночной энцефалопатией, гепаторенальным синдромом – ПДФ
Summary
Исследование по единому протоколу выполнялось в трех медицинских организациях: ГБУЗ «НИИ СП им. В исследование включено 52 пациента с печеночной недостаточностью: 14 – с острой (ОПечН) (ALF – acute liver failure), 38 – с декомпенсацией хронической печеночной недостаточности (острая печеночная недостаточность на фоне хронической – ACLF – acute-on-chronic liver failure) (ОХПечН) без комы. Точки забора и количество выполненных исследований представлены в табл. 3. При обработке результатов учитывались только те случаи, когда были получены данные в парных точках забора (до и после процедуры, до процедуры и на следующее утро, до, после процедуры и слив). Для интегральной оценки клинического статуса больных использовали шкалу MELD (Model for End. Количество операций ЭГК Число пациентов, всего Средний возраст Доля мужчин Доля пациентов с декомпенсацией ОХПечН (ACLF) Доля пациентов с ОПечН (ALF) без комы Доля пациентов с гепаторенальным синдромом (ГРС) Общий билирубин, мкмоль/л МНО Креатинин, мкмоль/л Шкала MELD, балл Летальность (госпитальная)
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
