Schönfelder Kristina, Hirsch Luisa Katharina, Kribben Andreas, Jahn Michael, Tyczynski Bartosz, Friebus-Kardash Justa
Department of Nephrology, University of Duisburg-Essen, University Hospital Essen, Essen Hufelandstr. 55, 45147, Essen, Germany.
Department of Cardiology, Electrophysiology, Nephrology, Geriatric Medicine and Intensive Care Medicine, Alfred Krupp Hospital, Essen, Germany.
BMC Nephrol. 2025 Aug 4;26(1):432. doi: 10.1186/s12882-025-04342-6.
As many as 30% of critically ill patients in intensive care units experience acute liver dysfunction with hyperbilirubinemia as a part of multiorgan failure that is associated with poor outcome. This retrospective cohort study was aimed at comparing CytoSorb and ADVOS in terms of bilirubin removal and overall survival among critically ill patients with hyperbilirubinemia ≥ 7 mg/dL.
At the University Hospital Essen, between January 2021 and March 2024, 71 patients were treated with CytoSorb integrated in a continuous veno-venous hemodiafiltration (CVVHDF) circuit, and 71 patients were treated with ADVOS. Each therapy session lasted 24 h. We separately analyzed the subgroup of patients with acute-on-chronic liver failure (ACLF), in which 31 patients were treated with CytoSorb and 66 patients were treated with ADVOS.
The first single sessions of both CytoSorb with CVVHDF and ADVOS were associated with a statistically significant decrease in total serum bilirubin levels (Cytosorb, 20 to 14 mg/dL, p < 0.0001; ADVOS, 16 to 14 mg/dL, p < 0.0001), but the percentage bilirubin reduction was more pronounced for CytoSorb treatment (26% vs. 17%, p = 0.0002). The number of days of treatment was similar for both groups (3 vs. 4, p = 0.07). After completion of therapy, serum levels of total bilirubin had decreased significantly; 19.9 to 11.3 mg/dl (p < 0.0001) in the CytoSorb group and 16.3 to 14.0 mg/dL (p = 0.003) in the ADVOS group. The relative bilirubin reduction was significantly higher after application of CytoSorb than after treatment with ADVOS (35% (IQR 19,54) vs. 15% (IQR - 11;54), p < 0.0001). Regarding patients with ACLF, relative reduction of bilirubin after the first session as well as after the completion of liver support was significantly higher among patients who were treated with CVVHDF and CytoSorb than among those patients who received ADVOS. The relative removal of creatinine and urea nitrogen was significantly higher after ADVOS treatment than after CytoSorb with CVVHDF treatment considering all critically ill patients as well as ACLF patients. Seven-day or in-hospital mortality rates were high among critically ill patients and patients with ACLF in both liver support groups.
Our results showed that CytoSorb and CVVHDF treatment performed better than ADVOS in bilirubin removal among critically ill patients with hyperbilirubinemia caused by acute liver dysfunction and in the subgroup of patients with ACLF. ADVOS was more efficient in eliminating creatinine and urea nitrogen than was CVVHDF with CytoSorb. Additional prospective randomized controlled trials are warranted to investigate the efficacy of hemoperfusion with CytoSorb for liver disease indications among critically ill patients.
Not applicable.
重症监护病房中多达30%的重症患者会出现急性肝功能障碍并伴有高胆红素血症，这是多器官功能衰竭的一部分，与不良预后相关。这项回顾性队列研究旨在比较细胞吸附疗法（CytoSorb）和体外白蛋白透析系统（ADVOS）在胆红素清除率和高胆红素血症≥7mg/dL的重症患者总体生存率方面的差异。
在埃森大学医院，2021年1月至2024年3月期间，71例患者接受了集成在连续性静脉-静脉血液透析滤过（CVVHDF）回路中的细胞吸附疗法治疗，71例患者接受了体外白蛋白透析系统治疗。每次治疗持续24小时。我们分别分析了慢性肝功能衰竭急性加重（ACLF）患者亚组，其中31例患者接受了细胞吸附疗法治疗，66例患者接受了体外白蛋白透析系统治疗。
细胞吸附疗法联合CVVHDF和体外白蛋白透析系统的首次单次治疗均与血清总胆红素水平的显著降低相关（细胞吸附疗法，从20mg/dL降至14mg/dL，p<0.0001；体外白蛋白透析系统，从16mg/dL降至14mg/dL，p<0.0001），但细胞吸附疗法治疗的胆红素降低百分比更为明显（26%对17%，p=0.0002）。两组的治疗天数相似（3天对4天，p=0.07）。治疗结束后，血清总胆红素水平显著降低；细胞吸附疗法组从19.9mg/dL降至11.3mg/dL（p<0.0001），体外白蛋白透析系统组从16.3mg/dL降至14.0mg/dL（p=0.003）。应用细胞吸附疗法后的相对胆红素降低幅度显著高于体外白蛋白透析系统治疗后（35%（四分位距19,54）对15%（四分位距-11;54），p<0.0001）。对于ACLF患者，接受CVVHDF和细胞吸附疗法治疗的患者在首次治疗后以及肝脏支持治疗结束后的胆红素相对降低幅度显著高于接受体外白蛋白透析系统治疗的患者。考虑所有重症患者以及ACLF患者，体外白蛋白透析系统治疗后的肌酐和尿素氮相对清除率显著高于细胞吸附疗法联合CVVHDF治疗。两个肝脏支持治疗组的重症患者和ACLF患者的7天或住院死亡率都很高。
我们的结果表明，在由急性肝功能障碍引起的高胆红素血症的重症患者以及ACLF患者亚组中，细胞吸附疗法和CVVHDF治疗在胆红素清除方面比体外白蛋白透析系统表现更好。体外白蛋白透析系统在消除肌酐和尿素氮方面比联合细胞吸附疗法的CVVHDF更有效。有必要进行额外的前瞻性随机对照试验，以研究细胞吸附疗法血液灌流对重症患者肝病适应症的疗效。
不适用。
