Extracorporeal albumin dialysis in critically ill patients with liver failure: Comparison of four different devices—A retrospective analysis

Abstract

Background: Besides standard medical therapy and critical care monitoring, extracorporeal liver support may provide a therapeutic option in patients with liver failure. However, little is known about detoxification capabilities, efficacy, and efficiency among different devices. Methods: Retrospective single-center analysis of patients treated with extracorporeal albumin dialysis. Generalized Estimating Equations with robust variance estimator were used to account for repeated measurements of several cycles and devices per patient. Results: Between 2015 and 2021 n = 341 cycles in n = 96 patients were eligible for evaluation, thereof n = 54 (15.8%) treatments with Molecular Adsorbent Recirculating System, n = 64 (18.7%) with OpenAlbumin, n = 167 (48.8%) Advanced Organ Support treatments, and n = 56 (16.4%) using Single Pass Albumin Dialysis. Albumin dialysis resulted in significant bilirubin reduction without differences between the devices. However, ammonia levels only declined significantly in ADVOS and OPAL. First ECAD cycle was associated with highest percentage reduction in serum bilirubin. With the exception of SPAD all devices were able to remove the water-soluble substances creatinine and urea and stabilized metabolic dysfunction by increasing pH and negative base excess values. Platelets and fibrinogen levels frequently declined during treatment. Periprocedural bleeding and transfusion of red blood cells were common findings in these patients. Conclusions: From this clinical perspective ADVOS and OPAL may provide higher reduction capabilities of liver solutes (i.e. bilirubin and ammonia) in comparison to MARS and SPAD. However, further prospective studies comparing the effectiveness of the devices to support liver impairment (i.e. bile acid clearance or albumin binding capacity) as well as markers of renal recovery are warranted.

Interaction between the albumin-bilirubin score and nutritional risk index in the prediction of post-hepatectomy liver failure

“…Albumin has been shown to have therapeutic effects in patients with liver failure. For example, Sommerfeld et al [ 26 ] reported that extracorporeal albumin dialysis enhanced bile acid clearance or albumin binding in the livers of patients with severe liver failure, thus protecting against further damage.…”

Idiosyncratic Drug-Induced Liver Injury in a Healthy Patient following PCSK9-Inhibitor Injection

“…Open albumin dialysis (OPAL) was first introduced in 2014. It is analogous to the molecular absorbent recirculating system (MARS) liver support system but with a greater filter surface, and a recent study comparing extracorporeal albumin dialysis showed that OPAL may provide higher reduction capabilities of liver solutes (i.e., bilirubin and ammonia) in comparison to MARS [ 10 ].…”