Albumindialyse bei Patienten mit sekundärem Leberversagen nach kardiogenem Schock

The Molecular Adsorbent Recirculating System (MARS) has been proven to prolong survival in patients with acute on chronic liver failure. MARS is a liver support therapy that is based on a modified dialysis using an albumin-containing dialysate, which is recirculated and on-line perfused through charcoal and anion exchanger columns. It allows the selective removal of albumin-bound substances from the blood. Despite advances in medical therapy and technology, the prognosis of patients with cardiogenic shock remains poor. Mortality rates are as high as 80%, often due to persistent multiple organ failure. To find out whether patients with hypoxic liver failure following cardiogenic shock after cardiac surgery might benefit from MARS, we performed a prospective, randomized, controlled, single center study. The primary objective was to prove that MARS improves survival during ICU stay. A total of 40 patients were included between 8/00 and 6/02; 20 patients in the MARS group (M) and 20 in the standard therapy group without MARS treatment (ST). All had bilirubin levels > 8 mg/dl. Both groups had a similar risk profile. The M patients received MARS for 3 consecutive days - if bilirubin was still >6 mg/dl afterwards, MARS was continued. The ST group received conventional therapy. For ethical reasons, ST patients with increasing bilirubin levels > 15 mg/dl later received MARS treatments (SM, n=13). Results We had 8 ICU survivors in the M group (40%) (n=20), compared to 1 (14.3%; p=0.438) in the group never treated with MARS (n=7). We conclude that despite the limited number of patients included in this analysis, MARS can be recommended for patients with acute, hypoxic liver failure as it can prolong survival. Further studies in similar patient cohorts are needed to verify these findings.