Brief Articles
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World J Gastroenterol. Jun 28, 2009; 15(24): 3015-3024
Published online Jun 28, 2009. doi: 10.3748/wjg.15.3015
Survival predictors in patients treated with a molecular adsorbent recirculating system
Taru Kantola, Anna-Maria Koivusalo, Satu Parmanen, Krister Höckerstedt, Helena Isoniemi
Taru Kantola, Anna-Maria Koivusalo, Department of Anesthesiology and Intensive Care Medicine, Surgical Hospital of Helsinki, Helsinki University Central Hospital, PO Box 263, FIN-0029 HUCH, Helsinki, Finland
Satu Parmanen, Department of Mathematics and Statistics, University of Helsinki, PO Box 68 FI-00014, Finland
Krister Höckerstedt, Helena Isoniemi, Transplantation and Liver Surgery Clinic, Helsinki University Central Hospital, PO Box 263, FIN-0029 HUCH, Helsinki, Finland
Author contributions: Kantola T, Koivusalo AM, Höckerstedt K and Isoniemi H designed the research; Kantola T and Koivusalo AM performed the research; Parmanen S prepared the mathematics and the statistical solutions applied in the study; Kantola T and Parmanen S analyzed the data; Kantola T and Isoniemi H wrote the paper.
Correspondence to: Dr. Taru Kantola, Department of Anesthesiology and Intensive Care Medicine, Surgical Hospital of Helsinki, Helsinki University Central Hospital, PO Box 263, FIN-0029 HUCH, Helsinki, Finland. taru.kantola@hus.fi
Telephone: +358-40-8431551
Fax: +358-9-654294
Received: February 27, 2009
Revised: May 25, 2009
Accepted: June 1, 2009
Published online: June 28, 2009
Abstract

AIM: To identify prognostic factors for survival in patients with liver failure treated with a molecular adsorbent recirculating system (MARS).

METHODS: MARS is a liver-assisting device that has been used in the treatment of liver failure to enable native liver recovery, and as a bridge to liver transplantation (LTX). We analyzed the 1-year outcomes of 188 patients treated with MARS, from 2001 to 2007, in an intensive care unit specializing in liver disease. Demographic, clinical and laboratory parameters were recorded before and after each treatment. One-year survival and the number of LTXs were recorded. Logistic regression analysis was performed to determine factors predicting survival.

RESULTS: The study included 113 patients with acute liver failure (ALF), 62 with acute-on-chronic liver failure (AOCLF), 11 with graft failure (GF), and six with miscellaneous liver failure. LTX was performed for 29% of patients with ALF, 18% with AOCLF and 55% with GF. The overall 1-year survival rate was 74% for ALF, 27% for AOCLF, and 73% for GF. The poorest survival rate, 6%, was noted in non-transplanted patients with alcohol-related AOCLF and cirrhosis, whereas, patients with enlarged and steatotic liver had 55% survival. The etiology of liver failure was the most important predictor of survival (P < 0.0001). Other prognostic factors were encephalopathy (P = 0.001) in paracetamol-related ALF, coagulation factors (P = 0.049) and encephalopathy (P = 0.064) in non-paracetamol-related toxic ALF, and alanine aminotransferase (P = 0.013) and factor V levels (P = 0.022) in ALF of unknown etiology.

CONCLUSION: The etiology of liver disease was the most important prognostic factor. MARS treatment appears to be ineffective in AOCLF with end-stage cirrhosis without an LTX option.

Keywords: Molecular adsorbent recirculating system; Prognostic factors; Acute liver failure; Acute-on-chronic liver failure; Liver transplantation