An Evaluation of the Usefulness of Extracorporeal Liver Support Techniques in Patients Hospitalized in the ICU for Severe Liver Dysfunction Secondary to Alcoholic Liver Disease
| Autor: | Mariusz Piechota, Anna Piechota |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Alcoholic liver disease
medicine.medical_specialty Modified Maddrey’s Discriminant Function Extracorporeal Sequential Organ Failure Assessment 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Internal medicine Anesthesiology medicine Intensive care medicine Simplified Acute Physiology Score II Creatinine Single Pass Albumin Dialysis Acute Physiology and Chronic Health Evaluation II Hepatology APACHE II business.industry Standard treatment Mortality rate 030208 emergency & critical care medicine medicine.disease Fractionated Plasma Separation and Adsorption Infectious Diseases chemistry SAPS II 030211 gastroenterology & hepatology business Model of End-Stage Liver Disease UNOS Modification Research Article |
| Zdroj: | Hepatitis Monthly |
| ISSN: | 1735-3408 1735-143X |
| DOI: | 10.5812/hepatmon.34127 |
| Popis: | Background The mortality rate in patients with severe liver dysfunction secondary to alcoholic liver disease (ALD) who do not respond to the standard treatment is exceptionally high. Objectives The main aim of this study was to evaluate the usefulness of applying extracorporeal liver support techniques to treat this group of patients. Patients and Methods The data from 23 hospital admissions of 21 patients with ALD who were admitted to the department of anesthesiology and intensive therapy (A&IT) at the Dr Wł. Biegański Regional Specialist Hospital in Łódź between March 2013 and July 2015 were retrospectively analyzed. Results A total of 111 liver dialysis procedures were performed during the 23 hospitalizations, including 13 dialyses using fractionated plasma separation and adsorption (FPSA) with the Prometheus® system, and 98 procedures using the single pass albumin dialysis (SPAD) system. Upon admission to the intensive care unit (ICU), the median (interquartile range [IQR]) Glasgow coma scale (GCS), sequential organ failure assessment (SOFA), acute physiology and chronic health evaluation (APACHE) II, and simplified acute physiology score (SAPS) II scores were 15 (14 - 15), 9 (7 - 13), 17 (14 - 24), and 32 (22 - 50), respectively. The ICU, 30-day, and three-month mortality rates were 43.48%, 39.13%, and 73.91%, respectively. As determined by the receiver operative characteristic (ROC) analysis for single-factor models, the significant predictors of death in the ICU included the patients’ SOFA, APACHE II, SAPS II, and model of end-stage liver disease modified by the united network for organ sharing (MELD UNOS Modification) scores; the duration of stay (in days) in the A&IT Department; and bile acid, creatinine and albumin levels upon ICU admission. The ROC analysis indicated the significant discriminating power of the SOFA, APACHE II, SAPS II, and MELD UNOS modification scores on the three-month mortality rate. Conclusions The application of extracorporeal liver support techniques in patients with severe liver dysfunction secondary to ALD appears justified in the subset of patients with MELD UNOS Modification scores of 18 - 30. |
| Databáze: | OpenAIRE |
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