Popescu Mihai, David Corina, Marcu Alexandra, Olita Mihaela Roxana, Mihaila Mariana, Tomescu Dana
Department of Anaesthesia and Intensive Care, "Carol Davila" University of Medicine and Pharmacy, 022328 Bucharest, Romania.
Department of Anaesthesia and Intensive Care, Fundeni Clinical Institute, 022328 Bucharest, Romania.
J Clin Med. 2023 Mar 14;12(6):2258. doi: 10.3390/jcm12062258.
Liver failure represents a life-threatening organ dysfunction with liver transplantation as the only proven curable therapy to date. Liver assist devices have been extensively researched to either bridge such patients to transplantation or promote spontaneous recovery. The aim of our study was to compare two such devices, the Molecular Adsorbent Recirculating System (MARS) and CytoSorb, in patients with liver failure.
We retrospectively included 15 patients who underwent MARS during their intensive care unit stay and matched them to 15 patients who underwent hemoadsorption using CytoSorb. Clinical and paraclinical data obtained after each individual session, after the course of treatment, as well as at the end of the intensive care unit stay were compared between the two groups.
Single sessions of CytoSorb and MARS were both associated with a significant decrease in bilirubin ( = 0.04 and = 0.04, respectively) and ammonia levels ( = 0.04 and = 0.04, respectively), but only CytoSorb therapy was associated with a decrease in lactate dehydrogenase levels ( = 0.04) and in platelet count ( = 0.04). After the course of treatment, only CytoSorb was associated with a significant decrease in lactate ( = 0.01), bilirubin ( = 0.01), ammonia ( = 0.02), and lactate dehydrogenase levels ( = 0.01), while patients treated with MARS did not show any improvement in paraclinical liver tests. In addition, only CytoSorb treatment was associated with a significant improvement in the Model for End-Stage Liver Disease Score ( = 0.04).
In conclusion, our results show a potential benefit of CytoSorb in rebalancing liver functional tests in patients with liver failure compared to MARS but the exact effects on patient outcome, including hospital length of stay and survival, should be further investigated in randomized control trials.
肝衰竭是一种危及生命的器官功能障碍，肝移植是迄今为止唯一被证实可治愈的疗法。肝辅助装置已被广泛研究，用于将此类患者过渡到移植或促进自发恢复。我们研究的目的是比较两种此类装置，即分子吸附循环系统（MARS）和CytoSorb，在肝衰竭患者中的应用。
我们回顾性纳入了15例在重症监护病房住院期间接受MARS治疗的患者，并将他们与15例接受CytoSorb血液吸附治疗的患者进行匹配。比较两组在每次治疗后、治疗过程结束时以及重症监护病房住院结束时获得的临床和辅助临床数据。
单次使用CytoSorb和MARS均与胆红素水平（分别为P = 0.04和P = 0.04）和氨水平（分别为P = 0.04和P = 0.04）的显著降低相关，但只有CytoSorb治疗与乳酸脱氢酶水平降低（P = 0.04）和血小板计数降低（P = 0.04）相关。治疗过程结束后，只有CytoSorb与乳酸（P = 0.01）、胆红素（P = 0.01）、氨（P = 0.02）和乳酸脱氢酶水平显著降低（P = 0.01）相关，而接受MARS治疗的患者在辅助临床肝功能检查中未显示任何改善。此外，只有CytoSorb治疗与终末期肝病模型评分显著改善相关（P = 0.04）。
总之,我们的结果表明，与MARS相比，CytoSorb在恢复肝衰竭患者肝功能检查平衡方面具有潜在益处，但对患者预后的确切影响,包括住院时间和生存率，应在随机对照试验中进一步研究。
