Survival predictors in patients treated with a molecular adsorbent recirculating system

作     者：Taru Kantola Anna-Maria Koivusalo Satu Parmanen Krister Hckerstedt Helena Isoniemi 

作者机构：Department of Anesthesiology and Intensive Care MedicineSurgical Hospital of HelsinkiHelsinki University Central Hospital Department of Mathematics and Statistics University of Helsinki Transplantation and Liver Surgery ClinicHelsinki University Central Hospital 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2009年第15卷第24期

页      面：3015-3024页

核心收录：

学科分类：1002[医学-临床医学] 10[医学] 

基　　金：Supported by A Scientific Grant From the Helsinki University Central Hospital Research Fund(EVO) 

主　　题：再循环系统 分子吸附 预测 患者 治疗 

摘      要：AIM:To identify prognostic factors for survival in patients with liver failure treated with a molecular adsorbent recirculating system(MARS). METHODS:MARS is a liver-assisting device that has been used in the treatment of liver failure to enable native liver recovery,and as a bridge to liver transplantation(LTX).We analyzed the 1-year outcomes of 188 patients treated with MARS,from 2001 to 2007, in an intensive care unit specializing in liver disease. Demographic,clinical and laboratory parameters were recorded before and after each treatment.One-year survival and the number of LTXs were recorded.Logistic regression analysis was performed to determine factors predicting survival. RESULTS:The study included 113 patients with acute liver failure(ALF),62 with acute-on-chronic liver failure(AOCLF),11 with graft failure(GF),and six with miscellaneous liver failure.LTX was performed for 29% of patients with ALF,18% with AOCLF and 55%with GF.The overall 1-year survival rate was 74% for ALF,27% for AOCLF,and 73% for GF.The poorest survival rate,6%,was noted in non-transplanted patients with alcohol-related AOCLF and cirrhosis,whereas,patients with enlarged and steatotic liver had 55% survival.The etiology of liver failure was the most important predictor of survival(P0.0001).Other prognostic factors were encephalopathy(P=0.001)in paracetamol-related ALF, coagulation factors(P=0.049)and encephalopathy(P=0.064)in non-paracetamol-related toxic ALF,and alanine aminotransferase(P=0.013)and factor V levels(P =0.022)in ALF of unknown etiology. CONCLUSION:The etiology of liver disease was the most important prognostic factor.MARS treatment appears to be ineffective in AOCLF with end-stage cirrhosis without an LTX option.