Use of the Molecular Adsorbent Recirculating System in Acute Liver Failure: Results of a Multicenter Propensity Score-Matched Study*
| Autor: | Constantine J. Karvellas, Brianne M Shropshire, Jody C. Olson, Babusai Rapaka, Jaime L. Speiser, David L. Bigam, Ram Subramanian, Ravi Vora, Mary Flynn, Andrew J MacDonald, Valerie Durkalski-Mauldin, Juan G. Abraldes |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
Male Models Molecular medicine.medical_specialty medicine.medical_treatment Hemodynamics Critical Care and Intensive Care Medicine Gastroenterology Alberta Cohort Studies Tertiary Care Centers chemistry.chemical_compound Internal medicine medicine Humans Propensity Score Hepatic encephalopathy Retrospective Studies Mechanical ventilation Creatinine business.industry Retrospective cohort study Odds ratio Liver Failure Acute Middle Aged medicine.disease Liver Transplantation Acetaminophen Transplantation Logistic Models chemistry Female business medicine.drug |
| Zdroj: | Critical Care Medicine. 50:286-295 |
| ISSN: | 0090-3493 |
| DOI: | 10.1097/ccm.0000000000005194 |
| Popis: | Objectives The molecular adsorbent recirculating system removes water-soluble and albumin-bound toxins and may be beneficial for acute liver failure patients. We compared the rates of 21-day transplant-free survival in acute liver failure patients receiving molecular adsorbent recirculating system therapy and patients receiving standard medical therapy. Design Propensity score-matched retrospective cohort analysis. Setting Tertiary North American liver transplant centers. Patients Acute liver failure patients receiving molecular adsorbent recirculating system at three transplantation centers (n = 104; January 2009-2019) and controls from the U.S. Acute Liver Failure Study Group registry. Interventions Molecular adsorbent recirculating system treatment versus standard medical therapy (control). Measurements and main results One-hundred four molecular adsorbent recirculating system patients were propensity score-matched (4:1) to 416 controls. Using multivariable conditional logistic regression adjusting for acute liver failure etiology (acetaminophen: n = 248; vs nonacetaminophen: n = 272), age, vasopressor support, international normalized ratio, King's College Criteria, and propensity score (main model), molecular adsorbent recirculating system was significantly associated with increased 21-day transplant-free survival (odds ratio, 1.90; 95% CI, 1.07-3.39; p = 0.030). This association remained significant in several sensitivity analyses, including adjustment for acute liver failure etiology and propensity score alone ("model 2"; molecular adsorbent recirculating system odds ratio, 1.86; 95% CI, 1.05-3.31; p = 0.033), and further adjustment of the "main model" for mechanical ventilation, and grade 3/4 hepatic encephalopathy ("model 3"; molecular adsorbent recirculating system odds ratio, 1.91; 95% CI, 1.07-3.41; p = 0.029). In acetaminophen-acute liver failure (n = 51), molecular adsorbent recirculating system was associated with significant improvements (post vs pre) in mean arterial pressure (92.0 vs 78.0 mm Hg), creatinine (77.0 vs 128.2 µmol/L), lactate (2.3 vs 4.3 mmol/L), and ammonia (98.0 vs 136.0 µmol/L; p ≤ 0.002 for all). In nonacetaminophen acute liver failure (n = 53), molecular adsorbent recirculating system was associated with significant improvements in bilirubin (205.2 vs 251.4 µmol/L), creatinine (83.1 vs 133.5 µmol/L), and ammonia (111.5 vs 140.0 µmol/L; p ≤ 0.022 for all). Conclusions Treatment with molecular adsorbent recirculating system is associated with increased 21-day transplant-free survival in acute liver failure and improves biochemical variables and hemodynamics, particularly in acetaminophen-acute liver failure. |
| Databáze: | OpenAIRE |
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