Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine, University Hospital Marburg, Philipps University, Baldingerstrasse, 35033, Marburg, Germany.
Department of Cardiothoracic Surgery, University Hospital Marburg, Philipps University, Baldingerstrasse, 35033, Marburg, Germany.
BMC Gastroenterol. 2019 Sep 3;19(1):160. doi: 10.1186/s12876-019-1077-y.
Extracorporeal liver support therapies (ELS) are technical options (for bridge-to-recovery as well as bridge-to-transplant) in patients with acute liver dysfunction (e.g. acute liver failure (ALF), acute-on chronic liver failure (AoCLF) or decompensated chronic liver disease (decomp. CLD)) to reduce effects of failing hepatic detoxification functions. The present study investigates the real-life utilization of ELS (annual incidences), mortality rates as well as data regarding specific populations of liver transplantation in Germany.
Data on patient cases receiving extracorporeal liver support therapy were identified in a nationwide data set from the Federal statistical Office of Germany from 1 January 2007 through 31 December 2015 and analyzed regarding in-hospital mortality, age- and sex-specific distribution and use of ELS in the context of liver transplantation. Mortality rates in patients with primary acute liver dysfunction and secondary acute liver dysfunction (in the context of cardiothoracic surgery) were evaluated.
Annual incidences of ELS use remained stable between 0.39/100.000 in 2007 and 0.47/100.000 ELS in 2015. In-hospital mortality rate was 51.49% in the 2886 evaluated patient cases. Mortality was higher in men (56.04%) than in women (43.70) in the observed time period between 2007 and 2015. ELS utilization and case-related liver transplantation rates were low (12.47%). Since 2012, the annual numbers for ELS therapy in cardiosurgical patients exceeded the frequency of ELS utilization in cases of primary liver dysfunction (mortality rates: 68.39% versus 40.63%).
ELS utilization remained stable between 2007 and 2015. Mortality rates are high in this patient population of acute liver dysfunction, especially in combination with case-related cardiothoracic surgery. ELS is rarely used in the setting of liver transplantation. In 2015, more than 50% of all ELS cases in Germany were performed in the context of cardiothoracic surgery.
体外肝支持治疗（ELS）是急性肝功能障碍患者（如急性肝衰竭（ALF）、慢加急性肝衰竭（AoCLF）或代偿性慢性肝病（代偿性 CLD））的技术选择（用于桥接恢复和桥接移植），以减少肝脏解毒功能衰竭的影响。本研究调查了德国 ELS 的实际应用（年发生率）、死亡率以及肝移植特定人群的数据。
从德国联邦统计局 2007 年 1 月 1 日至 2015 年 12 月 31 日的全国性数据集，确定接受体外肝支持治疗的患者病例数据，并分析住院死亡率、年龄和性别分布以及肝移植背景下 ELS 的应用。评估原发性急性肝功能障碍和继发性急性肝功能障碍（心胸外科背景下）患者的死亡率。
2007 年 ELS 使用率为 0.39/100000，2015 年为 0.47/100000，年发生率保持稳定。在 2886 例评估病例中，住院死亡率为 51.49%。在 2007 年至 2015 年期间，男性死亡率（56.04%）高于女性（43.70%）。ELS 的利用率和与病例相关的肝移植率较低（12.47%）。自 2012 年以来，心胸外科患者 ELS 治疗的年例数超过了原发性肝功能障碍患者 ELS 使用率（死亡率：68.39%对 40.63%）。
2007 年至 2015 年期间，ELS 的使用率保持稳定。急性肝功能障碍患者的死亡率很高，尤其是在合并与病例相关的心胸外科手术的情况下。ELS 在肝移植中很少使用。2015 年，德国超过 50%的 ELS 病例是在心胸外科手术中进行的。
