Pinceaux Kieran, Bélicard Félicie, Coirier Valentin, Le Pabic Estelle, Guillot Pauline, Delamaire Flora, Painvin Benoît, Quelven Quentin, Lesouhaitier Mathieu, Maamar Adel, Gacouin Arnaud, Houssel-Debry Pauline, Boudjema Karim, Bardou-Jacquet Edouard, Tadié Jean-Marc, Reizine Florian, Camus Christophe
Service de Médecine Intensive - Réanimation, CHU de Rennes, 35000, Rennes, France.
Centre d'Investigation Clinique, CHU de Rennes, 35000, Rennes, France.
Ann Intensive Care. 2025 Aug 26;15(1):124. doi: 10.1186/s13613-025-01506-3.
Whether Molecular Adsorbent Recirculating System (MARS) dialysis and high-volume plasma exchange (HVPE) may improve survival in acute liver failure (ALF) remains unclear. A referral center retrospective cohort study was conducted on patients admitted to ICU with ALF and who fulfilled liver transplantation (LTx) criteria from 2000 to 2021.
The whole study period was divided into three 7-year consecutive periods (A, B, C) depending on the patients' date of admission. MARS was optionally performed only in periods A and B and HVPE was only performed in period C. Day-21 transplant-free survival (TFS) and day-28 overall survival (OS) were endpoints. The effect of MARS was assessed in periods A and B by comparing the patients treated with MARS with those not treated. Three treatment groups consisting of two different durations of total MARS therapy or no MARS were also compared. HVPE-treated patients (period C, n = 45) were compared to a control group of patients receiving no liver support or a short duration of MARS therapy that was not considered to be effective (over periods A, B, C, n = 126). Survival curves were compared by the Gehan-Breslow-Wilcoxon test and the logrank test.
199 patients were enrolled and distributed as follows: A, n = 68; B, n = 70; C, n = 61. TFS did not differ with and without MARS (p = 0.19). Although MARS duration therapy could not be predicted at the time of MARS initiation, the patients treated ≥ 17 h (≥ 3 sessions) had better survival compared to treatment < 17 h or no MARS (78.6%, 30.4%, 43.8%; p = 0.0002). TFS was 55.6% versus 38.1% in the HVPE- and control groups (p = 0.003; adjusted HR 0.54 [0.32-0.93], p = 0.0257) and OS was 75.9% and 52.9%, respectively (p = 0.03).
MARS therapy improved TFS only in patients who received ≥ 3 sessions. Compared with controls, HVPE-treated patients experienced improved transplant-free and overall survival.
分子吸附循环系统（MARS）透析和大容量血浆置换（HVPE）是否能提高急性肝衰竭（ALF）患者的生存率尚不清楚。对2000年至2021年入住重症监护病房（ICU）且符合肝移植（LTx）标准的ALF患者进行了一项转诊中心回顾性队列研究。
根据患者的入院日期，将整个研究期分为三个连续的7年时间段（A、B、C）。MARS仅在A期和B期选择性进行，HVPE仅在C期进行。以第21天无移植生存（TFS）和第28天总生存（OS）为终点。通过比较接受MARS治疗的患者和未接受治疗的患者，评估A期和B期MARS的效果。还比较了由两种不同总MARS治疗持续时间或未进行MARS组成的三个治疗组。将接受HVPE治疗的患者（C期，n = 45）与未接受肝支持或接受短时间MARS治疗（认为无效，A、B、C期，n = 126）的对照组患者进行比较。通过Gehan-Breslow-Wilcoxon检验和对数秩检验比较生存曲线。
共纳入199例患者，分布如下：A期，n = 68；B期，n = 70；C期，n = 61。有无MARS治疗的TFS无差异（p = 0.19）。尽管在开始MARS治疗时无法预测MARS持续治疗时间，但与治疗时间<17小时或未进行MARS治疗相比，接受≥17小时（≥3次治疗）的患者生存率更高（78.6%、30.4%、43.8%；p = 0.0002）。HVPE组和对照组的TFS分别为55.6%和38.1%（p = 0.003；调整后HR 0.54 [0.32 - 0.93]，p = 0.0257），OS分别为75.9%和52.9%（p = 0.03）。
MARS治疗仅在接受≥3次治疗的患者中提高了TFS。与对照组相比，接受HVPE治疗的患者无移植生存率和总生存率均有所提高。
