Removal selectivity of Prometheus: A new extracorporeal liver support device

Abstract

To evaluate whether treatment with the Prometheus reg system significantly affects cytokines, coagulation factors and other plasma proteins. We studied nine patients with acute-on-chronic liver failure and accompanying renal failure. Prometheus reg therapy was performed on 2 consecutive days for up to 6 h in all patients. Several biochemical parameters and blood counts were assessed at regular time points during Prometheus reg treatment. We observed a significant decrease of both protein-bound (e.g. bile acids) and water-soluble (e.g. ammonia) substances after Prometheus reg therapy. Even though leukocytes increased during treatment (P<0.01), we found no significant changes of C-reactive protein, interleukin-6, and tumor necrosis factor-alpha plasma levels (all P>0.5). Further, antithrombin 3, factor II and factor V plasma levels did not decrease during Prometheus reg therapy (all P>0.5), and the INR remained unchanged (P=0.4). Plasma levels of total protein, albumin, and fibrinogen were also not altered during Prometheus reg treatment (all P>0.5). Finally, platelet count did not change significantly during therapy (P=0.6). Despite significant removal of protein-bound and water-soluble substances, Prometheus reg therapy did not affect the level of cytokines, coagulation factors or other plasma proteins. Thus, the filters and adsorbers used in the system are highly effective and specific for water-soluble substances and toxins bound to the albumin fraction.