OPTIMIZATION OF THE LENGTH OF INDIVIDUAL MARS TREATMENT IN PATIENTS WITH AOCHF

Abstract

A250 Aims: The aim of our study was to determine minimum MARS treatment and still obtain maximum removal of toxic substances in patients with acute-on-chronic liver failure as MARS allows the safe and efficient removal of both album in bound and water soluble toxic metabolites, including ammonia aromatic amino acids, tryptophan and related, phenolic and inbolic products, as well as benzodiazepines. Methods 47 patients suffering from AoCHF were treated. Hemodynamic parameters, base acid balance, hemogasanalysis and encephalopathy GCS, SOFA SCORE were monitored. Bilirubin, ammonium, lactate, creatinine and INR levels were monitored after 2 hours of treatment, after 4 hours, after 6 hours and at the end of the treatment. Results In 69% of the patients there was significant improvement in ammonium, bilirubin, lactate and creatinine levels and encephalopathy score compared to initial levels after 4 hours of treatment, P<0.02 for bilirubin, ammonium, creatinine, azotemia and encephalopathy levels, while there seemed to be no significant improvement after 4 hours and at the end of the treatment. These results were not connected to the different etiologies nor to the different ages of the patients. The statistical results were based on T student test. There does seem to be some correlation to length of base illness and the time interval from initial MARS treatment and the occurrence of jaundice and encephalopathy. Conclusions: If these findings are confirmed by a larger number of patients, MARS treatment could be limited to 4 hours. This would decrease treatment complicance and increase cost benefit ratios.