Influence of Advanced Organ Support (ADVOS) on Cytokine Levels in Patients with Acute-on-Chronic Liver Failure (ACLF)

Kaps, Leonard; Schleicher, Eva Maria; Montano, Carolina Medina; Bros, Matthias; Gairing, Simon Johannes; Ahlbrand, Constantin J.; Michel, Maurice Stephan; Klimpke, Pascal; Kremer, Wolfgang Maximilian; Holtz, Stefan; Boedecker, Simone; Galle, Peter R.; Kraus, Daniel; Schattenberg, Jörn M.; Labenz, Christian; Weinmann‐Menke, Julia

doi:10.3390/jcm11102782

Cited by 5 publications

(5 citation statements)

References 34 publications

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“…[15][16][17] However, cytokine levels in patients with liver dysfunction and ECAD were low and levels did not significantly change during treatment, either with MARS and SPAD 10 or ADVOS. 18 In the current investigation there were no differences between the devices in reducing creatinine and BUN. However, the efficacy of renal replacement therapy may be lower in SPAD in comparison to other devices, as the dialysate flow in SPAD is reduced to allow albumin bound substances to pass the hemodialysis filter into the albumin enriched dialysate.…”

Section: Discussionmentioning

confidence: 44%

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

Sommerfeld,

Neumann,

Becker

et al. 2023

Int J Artif Organs

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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.

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Section: Discussionmentioning

confidence: 44%

“… 15 – 17 However, cytokine levels in patients with liver dysfunction and ECAD were low and levels did not significantly change during treatment, either with MARS and SPAD 10 or ADVOS. 18 …”

Section: Discussionmentioning

confidence: 99%

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

Sommerfeld,

Neumann,

Becker

et al. 2023

Int J Artif Organs

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“…There have been contrasting results, with some indicating their benefit while others have shown no benefit [ 61 ]. The benefits observed have been mainly related to the improvement in biochemical parameters including bilirubin, ammonia, creatinine levels, and inflammatory cytokines among others, and consequently a benefit in encephalopathy [ 57 , 62 , 63 ]. Although the benefit in survival has been limited, research in this field continues due to the promising potential these devices have [ 59 ].…”

Section: Strategies To Face Current Challenges In Clinical Practicementioning

confidence: 99%

The Influence of Interdisciplinary Work towards Advancing Knowledge on Human Liver Physiology

Delgado–Coello

Navarro-Alvarez

Mas‐Oliva

2022

Cells

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The knowledge accumulated throughout the years about liver regeneration has allowed a better understanding of normal liver physiology, by reconstructing the sequence of steps that this organ follows when it must rebuild itself after being injured. The scientific community has used several interdisciplinary approaches searching to improve liver regeneration and, therefore, human health. Here, we provide a brief history of the milestones that have advanced liver surgery, and review some of the new insights offered by the interdisciplinary work using animals, in vitro models, tissue engineering, or mathematical models to help advance the knowledge on liver regeneration. We also present several of the main approaches currently available aiming at providing liver support and overcoming organ shortage and we conclude with some of the challenges found in clinical practice and the ethical issues that have concomitantly emerged with the use of those approaches.

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“…In advanced stages of cirrhosis, the immune system may even become exhausted under the constant inflammatory signaling, giving rise to an endotoxin tolerant state. An extreme outcome occurs in ACLF, where proinflammatory cytokines outbalance anti-inflammatory cytokines (e.g., IL-10) and a sepsis-like condition arises [10]. Besides their relevance for systemic inflammation, cytokines proved to be a valuable predictor for cirrhosis related complications.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Inflammatory Cytokine Levels in Hepatic and Jugular Veins of Patients with Cirrhosis

Kaps,

Medina-Montano,

Bros

et al. 2023

Mediators of Inflammation

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Background. Systemic inflammation with elevated inflammatory cytokines is a hallmark in patients with cirrhosis and the main driver of decompensation. There is insufficient data on whether inflammatory cytokine levels differ between hepatic and jugular veins, which may have implications for further immunological studies. Methods. Blood from the hepatic and jugular veins of 40 patients with cirrhosis was collected during hepatic venous pressure gradient (HVPG) measurements. Serum levels of 13 inflammatory cytokines (IL-1β, Int-α2, Int-γ, TNF-α, MCP-1, IL-6, IL-8, IL-10, IL-12p70, IL-17A, IL-18, IL-23, and IL-33) were quantified by cytometric bead array. Results. Cytokine levels of IFN-α2, IFN-γ, TNF-α, IL-6, IL-8, IL-10, IL-17A, IL-18, IL-23, and IL-33 were significantly elevated in patients with decompensated cirrhosis compared to patients with compensated cirrhosis. When comparing patients with clinically significant portal hypertension (CSPH, HVPG ≥ 10 mmHg) to patients without CSPH, there were significantly enhanced serum levels of IL-6 and IL-18 in the former group. There was no significant difference between cytokine serum levels between blood obtained from the jugular versus hepatic veins. Even in subgroup analyses stratified for an early cirrhosis stage (Child-Pugh (CP) A) or more decompensated stages (CP B/C), cytokine levels were similar. Conclusion. Cytokine levels increase with decompensation and increasing portal hypertension in patients with cirrhosis. There is no relevant difference in cytokine levels between hepatic and jugular blood in patients with cirrhosis.

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Influence of Advanced Organ Support (ADVOS) on Cytokine Levels in Patients with Acute-on-Chronic Liver Failure (ACLF)

Cited by 5 publications

References 34 publications

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

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

The Influence of Interdisciplinary Work towards Advancing Knowledge on Human Liver Physiology

Comparison of Inflammatory Cytokine Levels in Hepatic and Jugular Veins of Patients with Cirrhosis

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