General Intensive Care Unit, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Piazza OMS, 1, 24127, Bergamo, Italy.
J Artif Organs. 2024 Sep;27(3):261-268. doi: 10.1007/s10047-023-01409-9. Epub 2023 Jun 19.
ExtraCorporeal Liver Support (ECLS) systems were developed with the aim of supporting the liver in its detoxification function by clearing the blood from hepatic toxic molecules. We conducted a retrospective comparative analysis on patients presenting with liver failure who were treated with different extracorporeal techniques in our intensive care unit to evaluate and compare their detoxification abilities. To verify the effectiveness of the techniques, mass balance (MB) and adsorption per hour were calculated for total bilirubin (TB), direct bilirubin (DB), and bile acids (BA) from the concentrations measured. MB represents the total amount (mg or mcMol) of a molecule removed from a solution and is the only representative parameter to verify the purification effectiveness of one system as it is not affected by the continuous production of the molecules, released in the circulation from the tissues, as it is the case for the reduction rate (RR). The total adsorption per hour is calculated by the ratio between MB and the time duration and shows the adsorption ability in an hour. Our comparative study shows the superior adsorption capability of CytoSorb system regarding TB, DB, and BA, evaluated through the MB and adsorption per hour, in comparison with CPFA, MARS, Prometheus, and PAP. In conclusion, as extracorporeal purification in liver failure could be considered useful for therapeutic purposes, Cytosorb, being more performing than other systems considered, could represent the device of first choice.
体外肝脏支持 (ECLS) 系统的开发旨在通过清除血液中的肝毒性分子来支持肝脏的解毒功能。我们对在我们的重症监护病房中因肝衰竭而接受不同体外技术治疗的患者进行了回顾性对比分析，以评估和比较它们的解毒能力。为了验证这些技术的有效性，我们计算了总胆红素 (TB)、直接胆红素 (DB) 和胆汁酸 (BA) 的质量平衡 (MB) 和每小时吸附量，这些数据来自于测量的浓度。MB 代表从溶液中去除的分子的总量 (mg 或 mcMol)，是验证一个系统的净化效果的唯一代表性参数，因为它不受分子的连续产生的影响，而 RR 则是从组织释放到循环中的情况。总吸附量每小时是通过 MB 与时间的比值计算得出的，显示了每小时的吸附能力。我们的比较研究表明，CytoSorb 系统在 TB、DB 和 BA 方面的吸附能力优于 CPFA、MARS、Prometheus 和 PAP，这是通过 MB 和每小时吸附量来评估的。总之，由于体外肝脏衰竭的净化可以被认为是有治疗目的的，因此 Cytosorb 作为一种比其他被考虑的系统更具性能的方法，可能是首选设备。
