Liver-Support Therapies in Critical Illness—A Comparative Analysis of Procedural Characteristics and Safety
Extracorporeal liver-support therapies remain controversial in critically ill patients, as most studies have failed to show an improvement in outcomes. However, heterogeneous timing and inclusion criteria, an insufficient number of treatments, and the lack of a situation-dependent selection of avail...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-07-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/14/4669 |
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| author | Daniel Göth Christoph F. Mahler Florian Kälble Claudius Speer Louise Benning Felix C. F. Schmitt Maximilian Dietrich Ellen Krautkrämer Martin Zeier Uta Merle Christian Morath Mascha O. Fiedler Markus A. Weigand Christian Nusshag |
| author_facet | Daniel Göth Christoph F. Mahler Florian Kälble Claudius Speer Louise Benning Felix C. F. Schmitt Maximilian Dietrich Ellen Krautkrämer Martin Zeier Uta Merle Christian Morath Mascha O. Fiedler Markus A. Weigand Christian Nusshag |
| author_sort | Daniel Göth |
| collection | DOAJ |
| description | Extracorporeal liver-support therapies remain controversial in critically ill patients, as most studies have failed to show an improvement in outcomes. However, heterogeneous timing and inclusion criteria, an insufficient number of treatments, and the lack of a situation-dependent selection of available liver-support modalities may have contributed to negative study results. We retrospectively investigated the procedural characteristics and safety of the three liver-support therapies CytoSorb, Molecular Adsorbent Recirculating System (MARS) and therapeutic plasma exchange (TPE). Whereas TPE had its strengths in a shorter treatment duration, in clearing larger molecules, affecting platelet numbers less, and improving systemic coagulation and hemodynamics, CytoSorb and MARS were associated with a superior reduction in particularly small protein-bound and water-soluble substances. The clearance magnitude was concentration-dependent for all three therapies, but additionally related to the molecular weight for CytoSorb and MARS therapy. Severe complications did not appear. In conclusion, a better characterization of disease-driving as well as beneficial molecules in critically ill patients with acute liver dysfunction is crucial to improve the use of liver-support therapy in critically ill patients. TPE may be beneficial in patients at high risk for bleeding complications and impaired liver synthesis and hemodynamics, while CytoSorb and MARS may be considered for patients in whom the elimination of smaller toxic compounds is a primary objective. |
| first_indexed | 2024-03-11T00:57:52Z |
| format | Article |
| id | doaj.art-90c62abfe5ec47259368875b4795f327 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-11T00:57:52Z |
| publishDate | 2023-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-90c62abfe5ec47259368875b4795f3272023-11-18T19:52:12ZengMDPI AGJournal of Clinical Medicine2077-03832023-07-011214466910.3390/jcm12144669Liver-Support Therapies in Critical Illness—A Comparative Analysis of Procedural Characteristics and SafetyDaniel Göth0Christoph F. Mahler1Florian Kälble2Claudius Speer3Louise Benning4Felix C. F. Schmitt5Maximilian Dietrich6Ellen Krautkrämer7Martin Zeier8Uta Merle9Christian Morath10Mascha O. Fiedler11Markus A. Weigand12Christian Nusshag13Department of Nephrology, Heidelberg University Hospital, 69120 Heidelberg, GermanyDepartment of Nephrology, Heidelberg University Hospital, 69120 Heidelberg, GermanyDepartment of Nephrology, Heidelberg University Hospital, 69120 Heidelberg, GermanyDepartment of Nephrology, Heidelberg University Hospital, 69120 Heidelberg, GermanyDepartment of Nephrology, Heidelberg University Hospital, 69120 Heidelberg, GermanyDepartment of Anesthesiology, Heidelberg University Hospital, 69120 Heidelberg, GermanyDepartment of Anesthesiology, Heidelberg University Hospital, 69120 Heidelberg, GermanyDepartment of Nephrology, Heidelberg University Hospital, 69120 Heidelberg, GermanyDepartment of Nephrology, Heidelberg University Hospital, 69120 Heidelberg, GermanyDepartment of Gastroenterology, Heidelberg University Hospital, 69120 Heidelberg, GermanyDepartment of Nephrology, Heidelberg University Hospital, 69120 Heidelberg, GermanyDepartment of Anesthesiology, Heidelberg University Hospital, 69120 Heidelberg, GermanyDepartment of Anesthesiology, Heidelberg University Hospital, 69120 Heidelberg, GermanyDepartment of Nephrology, Heidelberg University Hospital, 69120 Heidelberg, GermanyExtracorporeal liver-support therapies remain controversial in critically ill patients, as most studies have failed to show an improvement in outcomes. However, heterogeneous timing and inclusion criteria, an insufficient number of treatments, and the lack of a situation-dependent selection of available liver-support modalities may have contributed to negative study results. We retrospectively investigated the procedural characteristics and safety of the three liver-support therapies CytoSorb, Molecular Adsorbent Recirculating System (MARS) and therapeutic plasma exchange (TPE). Whereas TPE had its strengths in a shorter treatment duration, in clearing larger molecules, affecting platelet numbers less, and improving systemic coagulation and hemodynamics, CytoSorb and MARS were associated with a superior reduction in particularly small protein-bound and water-soluble substances. The clearance magnitude was concentration-dependent for all three therapies, but additionally related to the molecular weight for CytoSorb and MARS therapy. Severe complications did not appear. In conclusion, a better characterization of disease-driving as well as beneficial molecules in critically ill patients with acute liver dysfunction is crucial to improve the use of liver-support therapy in critically ill patients. TPE may be beneficial in patients at high risk for bleeding complications and impaired liver synthesis and hemodynamics, while CytoSorb and MARS may be considered for patients in whom the elimination of smaller toxic compounds is a primary objective.https://www.mdpi.com/2077-0383/12/14/4669liver-support therapyacute liver dysfunctionacute liver failureCytoSorbMARStherapeutic plasma exchange |
| spellingShingle | Daniel Göth Christoph F. Mahler Florian Kälble Claudius Speer Louise Benning Felix C. F. Schmitt Maximilian Dietrich Ellen Krautkrämer Martin Zeier Uta Merle Christian Morath Mascha O. Fiedler Markus A. Weigand Christian Nusshag Liver-Support Therapies in Critical Illness—A Comparative Analysis of Procedural Characteristics and Safety Journal of Clinical Medicine liver-support therapy acute liver dysfunction acute liver failure CytoSorb MARS therapeutic plasma exchange |
| title | Liver-Support Therapies in Critical Illness—A Comparative Analysis of Procedural Characteristics and Safety |
| title_full | Liver-Support Therapies in Critical Illness—A Comparative Analysis of Procedural Characteristics and Safety |
| title_fullStr | Liver-Support Therapies in Critical Illness—A Comparative Analysis of Procedural Characteristics and Safety |
| title_full_unstemmed | Liver-Support Therapies in Critical Illness—A Comparative Analysis of Procedural Characteristics and Safety |
| title_short | Liver-Support Therapies in Critical Illness—A Comparative Analysis of Procedural Characteristics and Safety |
| title_sort | liver support therapies in critical illness a comparative analysis of procedural characteristics and safety |
| topic | liver-support therapy acute liver dysfunction acute liver failure CytoSorb MARS therapeutic plasma exchange |
| url | https://www.mdpi.com/2077-0383/12/14/4669 |
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