Efficacy of continuous plasma diafiltration therapy in critical patients with acute liver failure

• Published in: Journal of gastroenterology and hepatology Vol. 29; no. 4; pp. 782 - 786
• Main Authors: Komura, Takuya, Taniguchi, Takumi, Sakai, Yoshio, Yamashita, Tatsuya, Mizukoshi, Eishiro, Noda, Toru, Okajima, Masaki, Kaneko, Shuichi
• Format: Journal Article
• Language: English
• Published: Australia Blackwell Publishing Ltd 01.04.2014
• Subjects: acute kidney disease; acute liver failure; Adult; Bilirubin - blood; Biomarkers - blood; blood purification therapy; Critical Care - methods; Critical Illness; Female; Hemodiafiltration - methods; Humans; International Normalized Ratio; Liver Failure, Acute - diagnosis; Liver Failure, Acute - mortality; Liver Failure, Acute - therapy; Liver Function Tests; Male; Middle Aged; plasma exchange; Prothrombin Time; Safety; Severity of Illness Index; Treatment Outcome; acute kidney disease; blood purification therapy; plasma exchange; acute liver failure
• ISSN: 0815-9319; 1440-1746
• DOI: 10.1111/jgh.12440

Background and Aims Acute liver failure (ALF) is a critical illness with high mortality. Plasma diafiltration (PDF) is a blood purification therapy that is useful for ALF patients, but it is difficult to use when those patients have multiple organ failure or unstable hemodynamics. In these patients, symptoms are also likely to exacerbate immediately after PDF therapy. We developed continuous PDF (CPDF) as a new concept in PDF therapy, and assessed its efficacy and safety in ALF patients. Methods Ten ALF patients (gender: M/F 6/4, Age: 47 ± 14) were employed CPDF therapy. The primary outcomes were altered liver function, measured by the model for end‐stage liver disease (MELD) score, and total bilirubin and prothrombin time international normalized ratios (PT‐INR), 5 days after CPDF therapy. Secondary outcomes included sequential organ failure assessment (SOFA) scores, 5 days after CPDF therapy, and the survival rate 14 days after this therapy. Results The MELD score (34.5–28.0; P = 0.005), total bilirubin (10.9–7.25 mg/dL; P = 0.048), PT‐INR (1.89–1.31; P = 0.084), and SOFA score (10.0–7.5; P < 0.039) were improved 5 days after CPDF therapy. Nine patients were alive, and one patient died because of acute pancreatitis, complicated by ALF. There were no major adverse events related to this therapy under hemodynamic stability. Conclusion In the present study, CPDF therapy safely supported liver function and generally improved the condition of critically ill patients with ALF.