Albumin dialysis reduces portal pressure acutely in patients with severe alcoholic hepatitis

Sen, Sambit; Mookerjee, Rajeshwar P.; Cheshire, Lisa; Davies, Nathan; Williams, Roger; Jalan, Rajiv

doi:10.1016/j.jhep.2005.01.032

Cited by 97 publications

(54 citation statements)

References 31 publications

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“…In this regard, ALT activity can be viewed not only as an indicator of liver disease, but also as a gauge of general health. 4 Therefore, we fully agree with Dr. Lee and colleagues that aminotransferase measurement could have an important role as a preventive screening test, particularly in indi- HEPATOLOGY, Vol. 48, No.…”

Section: Serum Aminotransferase Activity and Mortality Risksupporting

confidence: 82%

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Ferenci

Kramer

2008

Hepatology

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major benefit of extracorporeal albumin dialysis in the management of patients with liver failure". We disagree with this last comment for the following reasons: (1) The response to therapy was clearly defined and the evaluation tools established at the time of the trial design, and methodological procedures were carefully conducted during the trial; (2) The use of new approaches for the evaluation of HE seems reasonable considering that, as the authors mention, there is no widely used scale in this setting. Moreover, the outcome measures implemented in the trial consider maintenance of the treatment effect through time such that any improvement in HE will also be identified. It is important to emphasize that the trial was neither designed nor powered to detect differences in survival. Thus, failure of albumin dialysis to reduce mortality does not necessarily translate to failure of the experimental arm; (3) The results of this trial are in agreement with previous studies assessing albumin dialysis in which improvements in both relevant physiopathological variables 3,4 and clinical outcomes, including survival, 5 have been noted; (4) Finally, we believe that the results of this trial should be analyzed not only in the context of treatment efficacy but should also be considered for their potential contribution in the design of new hypotheses, the selection of a more adequate target population, etc. In addition, it is important to remark that the use of albumin dialysis in severely affected patients was associated with no significant safety problems. From this perspective, we believe that the results of the trial by Hassanein et al. are truly encouraging and support ongoing large-scale randomized trials with major applications for the future development of artificial liver support in the treatment of liver failure. Reply:We thank Dr. Banares et al. for their comments to our editorial regarding the article by Hassanein et al. 1 on the effect of the Molecular Adsorbents Recirculating System (MARS) in patients with hepatic encephalopathy (HE) in advanced cirrhosis. As mentioned in our editorial, 2 studies in such patients are difficult to conduct, and the authors should be commended for their effort in carrying out the study. Nevertheless, there are weaknesses in the evaluation of the effects of MARS on HE, which limit the interpretation of the results. In fact, the primary outcome parameters (the "improvement proportion" [IP] and the "Hepatic Encephalopathy Scoring Algorithm" [HESA]) have never been described and validated before. This fact does not invalidate the findings, but calls for a very cautious interpretation of the results. We agree that the study was not powered to detect differences in survival. However, because this group of patients are not suitable candidates for liver transplantation, benefit of the improvement in HE remains questionable.Finally, we agree that MARS should be further evaluated in prospective trials, possibly by using more conventional criteria with the focus on gains in survival rate...

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Section: Serum Aminotransferase Activity and Mortality Risksupporting

confidence: 82%

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Ferenci

Kramer

2008

Hepatology

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“…Studies have suggested that MARS therapy improved the hemodynamic situation in patients with acute and acute-on-chronic liver failure [95]. Several groups observed an increase in arterial pressure, systemic vascular resistance index, a decrease in portal pressure and improvement of renal blood fl ow [95][96][97][98][99][100]. MARS may therefore be a therapeutic option of potential interest in patients with HH.…”

Section: Marsmentioning

confidence: 99%

Hypoxic hepatitis – epidemiology, pathophysiology and clinical management

Fuhrmann

Jäger

Zubkova³

et al. 2010

Wien Klin Wochenschr

114

112

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Hypoxic hepatitis (HH), also known as ischemic hepatitis or shock liver, is characterized by centrilobular liver cell necrosis and sharply increasing serum aminotransferase levels in a clinical setting of cardiac, circulatory or respiratory failure. Nowadays it is recognized as the most frequent cause of acute liver injury with a reported prevalence of up to 10% in the intensive care unit. Patients with HH and vasopressor therapy have a significantly increased mortality risk in the medical intensive care unit population. The main underlying conditions contributing to HH are low cardiac output and septic shock, although a multifactorial etiology is found in the majority of patients. HH causes several complications such as spontaneous hypoglycemia, respiratory insufficiency due to the hepatopulmonary syndrome, and hyperammonemia. HH reverses after successful treatment of the basic HH-causing disease. No specific therapies improving the hepatic function in patients with HH are currently established. Early recognition of HH and its underlying diseases and subsequent initiation of therapy is of central prognostic importance. The purpose of this review is to provide an update on the epidemiology, pathophysiology, and diagnostic and therapeutic options of HH.

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“…In this context, some hope can be placed in non-biological extracorporeal liver support techniques in this group of patients. Extracorporeal liver support (ECLS) can be provided using the fractionated plasma separation and adsorption (FPSA) technique with the Prometheus system, the Molecular Adsorbent Recirculating System (MARS) or single pass albumin dialysis (SPAD) [4][5][6][7][8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

An evaluation of the usefulness of extracorporeal liver support techniques in patients with severe liver dysfunction

Piechota¹,

Piechota

Misztal

et al. 2019

aoms

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A b s t r a c t Introduction:The mortality rate in patients with severe liver dysfunction with no option of transplantation is unacceptably high. The main aim of this study was to evaluate the usefulness of applying extracorporeal liver support (ECLS) techniques in this group of patients. Material and methods: Data from hospital admissions of 101 patients with severe liver dysfunction who were admitted to the department of anaesthesiology and intensive therapy between 2006 and 2015 were retrospectively analysed. The study group was divided into two subgroups. Standard medical therapy (SMT) was a subgroup of patients receiving standard medical therapy, and SMT + ECLS was a subgroup containing patients receiving standard medical therapy complemented by at least one extracorporeal liver support procedure. Extracorporeal liver support techniques used included fractionated plasma separation and adsorption and/or single pass albumin dialysis. Results: Significantly lower intensive care unit (ICU) mortality and 30-day mortality rates were found in the SMT + ECLS subgroup. No difference in 3-month mortality was identified between the two groups. In a multivariate model, independent risk factors for ICU mortality proved to be the SOFA score and prothrombin time. The highest discriminatory power for ICU mortality was demonstrated for the SOFA score, followed by APACHE II, SAPS II, MELD UNOS and GCS scores. For 30-day mortality, however, the best discriminatory power was shown for the SAPS II score, followed by SOFA, APACHE II, MELD UNOS and GCS scores. Conclusions: Further studies are needed to assess the contribution of non-biological extracorporeal liver support procedures to a decrease in mortality rates in the population of patients with severe liver dysfunction.

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Albumin dialysis reduces portal pressure acutely in patients with severe alcoholic hepatitis

Cited by 97 publications

References 31 publications

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Hypoxic hepatitis – epidemiology, pathophysiology and clinical management

An evaluation of the usefulness of extracorporeal liver support techniques in patients with severe liver dysfunction

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