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  • Poster presentation
  • Open Access

Therapeutic application of the Molecular Adsorbents Recirculating System in various pathogenic multiple organ dysfunction syndrome patients

  • 1,
  • 2 and
  • 3
Critical Care20048 (Suppl 1) :P152

https://doi.org/10.1186/cc2619

  • Published:

Keywords

  • Hepatic Encephalopathy
  • Sequential Organ Failure Assessment
  • Multiple Organ Dysfunction Syndrome
  • Liver Support
  • Lipopolysaccharide Binding Protein

Background

The Molecular Adsorbents Recirculating System (MARS) is a new promising artificial liver support therapy. The aim of this study was to assess the effectiveness of MARS to remove nitro oxide (NO) and cytokines in multiple organ dysfunction syndrome (MODS) with severe liver failure patients.

Methods

One hundred and ten single MARS treatments were performed with a length of 6–24 hours on 39 various pathogenic MODS patients (27 male/12 female) (see Table 1).

Table 1

Complication

n (%)

Renal failure/hepatorenal syndrome

28 (71.8%)

Disseminated intravascular coagulation

7 (17.9%)

Brain edema/hepatoencephalopathy above grade II

28 (71.8%)

Respiratory failure/acute respiratory distress syndrome

19 (48.7%)

Cardiovascular dysfunction

21 (53.8%)

Table 2

Parameter

Pretreatment

Post-treatment

P value

NO (μmol/l)

58.0 ± 22.9

25.2 ± 19.0

< 0.01

TNF-α (μg/l)

4.83 ± 2.6

1.70 ± 1.25

< 0.01

IL-2 (ng/l)

6.35 ± 2.13

4.25 ± 1.13

< 0.01

IL-6 (pg/ml)

394.9 ± 134.5

108.0 ± 117.3

< 0.01

IL-8 (ng/ml)

1.20 ± 0.63

0.52 ± 0.15

< 0.01

LBP (μg/ml)

16.2 ± 8.1

8.2 ± 5.1

< 0.01

Results

The MARS therapy was associated with a significant removal of NO and certain cytokines such as TNF-α, IL-2, IL-6, IL-8, and lipopolysaccharide binding protein (LBP) (see Table 2), together with a marked reduction of other nonwater-soluble albumin-bound toxins and water-soluble toxins. These were associated with an improvement of the patients' clinical conditions including hepatic encephalopathy, deranged hemodynamic situation and renal and respiratory function, thus resulting in a marked decrease of teh Sequential Organ Failure Assessment (SOFA) score and improved outcome: 16 patients were able to be discharged from the hospital or bridged to successful liver transplantation. The overall survival of 39 patients was 41%.

Conclusion

We can confirm the positive therapeutic impact and safety to use MARS on various pathogenic MODS patients associated with elevated levels of NO and cytokines.

Authors’ Affiliations

(1)
Department of Infectious Diseases, First People's Hospital of Foshan, China
(2)
ICU & Artificial Liver Support Center, Beijing DiTan Hospital, Beijing, China
(3)
ITU & Blood Purification Center, Beijing DiTan Hospital, Beijing, China

Copyright

© BioMed Central Ltd. 2004

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