Department of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine, Warsaw, Poland.
Department of Internal Medicine and Nephrodiabetology, Chair of Internal Diseases and Cardiology, Medical University of Łódź, Łódź, Poland.
Med Sci Monit. 2020 Jun 30;26:e923805. doi: 10.12659/MSM.923805.
BACKGROUND This study aimed to evaluate the Molecular Adsorbent Recirculating System (MARS) effectiveness in patients with alcohol-related acute-on-chronic liver failure (AoCLF) complicated with type 1 hepatorenal syndrome (HRS). So far, MARS efficacy and safety has been demonstrated in various acute liver failure scenarios. MATERIAL AND METHODS Data from 41 MARS procedures (10 patients with type 1 HRS, in the course of alcohol-related AoCLF were considered for this study. Biochemical tests of blood serum were performed before and after each procedure. The condition of patients was determined before and after the treatment with the use of the model for end-stage liver disease - sodium (MELD-Na) and the stage of encephalopathy severity based on the West Haven criteria. RESULTS During the observation period (20.5±13.9 days), 5 patients died, and the remaining 5 surviving patients were discharged from the hospital. In the group of 10, the 14-day survival, starting from the first MARS treatment, was 90%. The MARS procedure was associated with a 19% reduction in bilirubin (27.5±6.1 versus 22.3±4.0 mg/dL, P<0.001), 37% reduction in ammonia (44.1±22.5 versus 27.6±20.9 P<0.001), 27% reduction in creatinine (1.5±1.0 versus 1.1±0.6 mg/dL, P<0.001) and 14% reduction urea (83.8±36.1 versus 72.1±33.3, P<0.001) in blood serum samples, with stable hemodynamic parameters. In the group of patients discharged from the clinic (n=5), the MARS treatments resulted in an improvement in hepatic encephalopathy (West Haven; P=0.043), as well as a reduction in the MELD-Na score (P=0.015). CONCLUSIONS MARS is a hemodynamically safe method for supporting the function of the liver and the kidneys. Application of the MARS reduces the symptoms of encephalopathy in patients with alcohol-related type 1 HRS.
本研究旨在评估分子吸附再循环系统（MARS）在伴有 1 型肝肾综合征（HRS）的酒精性慢加急性肝衰竭（AoCLF）患者中的疗效。迄今为止，MARS 在各种急性肝衰竭情况下的疗效和安全性已得到证实。
对 41 例 MARS 治疗（10 例伴有 1 型 HRS 的酒精性 AoCLF 患者）进行回顾性研究。在每次治疗前后进行血清生化检测。采用终末期肝病模型钠（MELD-Na）和基于 West Haven 标准的脑病严重程度分期来评估患者治疗前后的病情。
在观察期间（20.5±13.9 天），5 例患者死亡，其余 5 例存活患者出院。在 10 例患者中，自首次 MARS 治疗开始的 14 天存活率为 90%。MARS 治疗可使胆红素降低 19%（27.5±6.1 与 22.3±4.0mg/dL，P<0.001），血氨降低 37%（44.1±22.5 与 27.6±20.9 P<0.001），肌酐降低 27%（1.5±1.0 与 1.1±0.6mg/dL，P<0.001），尿素降低 14%（83.8±36.1 与 72.1±33.3，P<0.001），且血流动力学参数稳定。在出院的 5 例患者中，MARS 治疗改善了肝性脑病（West Haven；P=0.043），降低了 MELD-Na 评分（P=0.015）。
MARS 是一种安全的肝肾功能支持方法。应用 MARS 可减轻酒精性 1 型 HRS 患者的脑病症状。
