Abstract
The aim of the study: to evaluate the efficacy of extracorporeal liver support systems in patients with acute liver failure of various etiologies.Material and methods. The study included 117 patients with acute liver failure of various etiologies. The main group consisted of 71 patients who received complex intensive therapy, including MARS-therapy and hemodiafiltration. The comparison group included 46 patients who received albumin dialysis (24 patients) and hemodiafiltration (22 patients) alone. The mean age of the patients was 34±5.6 years, the majority (56.4%) were men. Dynamic assessment of patients' severity was performed using Sequential Organ Failure Assessment (SOFA) and Model for End-Stage Liver Disease (MELD) scales.Results. A more significant reduction of SOFA and MELD scores was noted as early as by day 10 of intensive therapy in the main group with sequential use of extracorporeal liver detoxification methods — to 2.7±0.2 vs. 8.3±0.5 points (P=0.021) on SOFA and to 16.7±0.4 vs. 23.4±1.4 points (P=0.023) MELD scales. The use of a comprehensive approach to extracorporeal detoxification in acute decompensated liver failure increased the regression rate of multiple organ failure from 51.2 to 74.6% and reduced mortality from 47.8 to 25.4% (χ2=6.266; df=1; P=0.013). At the same time, the cumulative proportion of survivors depending on the type of complication within 30 days was 88.4% in the main group and 69.0% in the comparison group (χ2=4.164; df=1; P=0.042).Conclusion. A comprehensive approach to extracorporeal detoxification is highly effective, providing a more significant reduction of SOFA and MELD scores, increasing the proportion of regression of multiple organ dysfunction and reducing mortality.
Highlights
Acute liver failure (ALF), known as fulminant liver failure, is characterized by loss of function of 80–90% of hepatocytes, damage of many organ systems and high mortality rate [1, 2]
The use of a comprehensive approach to extracorporeal detoxification in acute decompensated liver failure increased the regression rate of multiple organ failure from 51.2 to 74.6% and reduced mortality from 47.8 to 25.4% (χ2=6.266; df=1; P=0.013)
Over the past three decades, significant advances in intensive care and emergency liver transplantation have dramatically changed the key features of ALF, with a remarkable drop in the frequency of cerebral edema and intracranial hypertension [9, 10]
Summary
Acute liver failure (ALF), known as fulminant liver failure, is characterized by loss of function of 80–90% of hepatocytes, damage of many organ systems and high mortality rate [1, 2]. The most common causes of ALF are viruses, drugs and toxins [3]. The incidence of ALF is approximately 5.5–6.2 per 1 million population per year [4]. In-hospital survival rates of patients with ALF without liver transplantation are 35–48% [5]. Over the past three decades, significant advances in intensive care and emergency liver transplantation have dramatically changed the key features of ALF, with a remarkable drop in the frequency of cerebral edema and intracranial hypertension [9, 10]
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