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Effects of fractionated plasma separation and adsorption on survival in patients with acute-on-chronic liver failure

Andreas Kribben, Guido Gerken, Sebastian Haag, Stefan Herget-Rosenthal, Ulrich Treichel, Christoph Betz, Christoph Sarrazin, Eric Hoste UGent, Hans Van Vlierberghe UGent and Angels Escorsell, et al. (2012) GASTROENTEROLOGY. 142(4). p.782-789
abstract
BACKGROUND & AIMS: Fractionated plasma separation and adsorption (FPSA) is an extracorporeal procedure that supports liver function by removing endogenous toxins that cause complications from acute-on-chronic liver failure (AOCLF). We performed a randomized trial to investigate survival of patients with AOCLF treated with FPSA. METHODS: Patients with AOCLF were randomly assigned to groups given a combination of FPSA and standard medical therapy (SMT) (FPSA group, n = 77) or only SMT (SMT group, n = 68). The Prometheus liver support system was used to provide 8 to 11 rounds of FPSA (minimum of 4 hours each) for 3 weeks. Primary end points were survival probabilities at days 28 and 90, irrespective of liver transplantation. RESULTS: Baseline clinical parameters and number of transplant patients were similar between study arms. Serum bilirubin level decreased significantly in the FPSA group but not in the SMT group. In an intention-to-treat analysis, the probabilities of survival on day 28 were 66% in the FPSA group and 63% in the SMT group (P = .70); on day 90, they were 47% and 38%, respectively (P = .35). Baseline factors independently associated with poor prognosis were high SOFA score, bleeding, female sex, spontaneous bacterial peritonitis, intermediate increases in serum creatinine concentration, and combination of alcoholic and viral etiology of liver disease. There were no differences between the 2 groups in the incidence of side effects. CONCLUSIONS: Among all patients with AOCLF, extracorporeal liver support with FPSA does not increase the probability of survival. Further studies are needed to assess whether therapy might be beneficial in specific subsets of patients.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
Mortality, Treatment, Organ Failure, Liver Disease, ADSORBENTS RECIRCULATING SYSTEM, HEPATORENAL-SYNDROME, PATHOPHYSIOLOGICAL BASIS, CURRENT MANAGEMENT, SUPPORT-SYSTEMS, DISEASE MELD, CIRRHOSIS, MODEL, PROMETHEUS(R), ASCITES
journal title
GASTROENTEROLOGY
Gastroenterology
volume
142
issue
4
pages
782 - 789
Web of Science type
Article
Web of Science id
000302296400027
JCR category
GASTROENTEROLOGY & HEPATOLOGY
JCR impact factor
12.821 (2012)
JCR rank
1/73 (2012)
JCR quartile
1 (2012)
ISSN
0016-5085
DOI
10.1053/j.gastro.2011.12.056
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
2096308
handle
http://hdl.handle.net/1854/LU-2096308
date created
2012-04-27 16:58:55
date last changed
2012-05-02 09:20:10
@article{2096308,
  abstract     = {BACKGROUND \& AIMS: Fractionated plasma separation and adsorption (FPSA) is an extracorporeal procedure that supports liver function by removing endogenous toxins that cause complications from acute-on-chronic liver failure (AOCLF). We performed a randomized trial to investigate survival of patients with AOCLF treated with FPSA.
METHODS: Patients with AOCLF were randomly assigned to groups given a combination of FPSA and standard medical therapy (SMT) (FPSA group, n = 77) or only SMT (SMT group, n = 68). The Prometheus liver support system was used to provide 8 to 11 rounds of FPSA (minimum of 4 hours each) for 3 weeks. Primary end points were survival probabilities at days 28 and 90, irrespective of liver transplantation.
RESULTS: Baseline clinical parameters and number of transplant patients were similar between study arms. Serum bilirubin level decreased significantly in the FPSA group but not in the SMT group. In an intention-to-treat analysis, the probabilities of survival on day 28 were 66\% in the FPSA group and 63\% in the SMT group (P = .70); on day 90, they were 47\% and 38\%, respectively (P = .35). Baseline factors independently associated with poor prognosis were high SOFA score, bleeding, female sex, spontaneous bacterial peritonitis, intermediate increases in serum creatinine concentration, and combination of alcoholic and viral etiology of liver disease. There were no differences between the 2 groups in the incidence of side effects.
CONCLUSIONS: Among all patients with AOCLF, extracorporeal liver support with FPSA does not increase the probability of survival. Further studies are needed to assess whether therapy might be beneficial in specific subsets of patients.},
  author       = {Kribben, Andreas and Gerken, Guido and Haag, Sebastian and Herget-Rosenthal, Stefan and Treichel, Ulrich and Betz, Christoph and Sarrazin, Christoph and Hoste, Eric and Van Vlierberghe, Hans and Escorsell, Angels and Hafer, Carsten and Schreiner, Oliver and Galle, Peter R and Mancini, Elena and Caraceni, Paolo and Karvellas, Constantine J and Salmhofer, Hermann and Knotek, Mladen and Gines, Pere and Kozik-Jaromin, Justyna and Rifai, Kinan},
  issn         = {0016-5085},
  journal      = {GASTROENTEROLOGY},
  keyword      = {Mortality,Treatment,Organ Failure,Liver Disease,ADSORBENTS RECIRCULATING SYSTEM,HEPATORENAL-SYNDROME,PATHOPHYSIOLOGICAL BASIS,CURRENT MANAGEMENT,SUPPORT-SYSTEMS,DISEASE MELD,CIRRHOSIS,MODEL,PROMETHEUS(R),ASCITES},
  language     = {eng},
  number       = {4},
  pages        = {782--789},
  title        = {Effects of fractionated plasma separation and adsorption on survival in patients with acute-on-chronic liver failure},
  url          = {http://dx.doi.org/10.1053/j.gastro.2011.12.056},
  volume       = {142},
  year         = {2012},
}

Chicago
Kribben, Andreas, Guido Gerken, Sebastian Haag, Stefan Herget-Rosenthal, Ulrich Treichel, Christoph Betz, Christoph Sarrazin, et al. 2012. “Effects of Fractionated Plasma Separation and Adsorption on Survival in Patients with Acute-on-chronic Liver Failure.” Gastroenterology 142 (4): 782–789.
APA
Kribben, A., Gerken, G., Haag, S., Herget-Rosenthal, S., Treichel, U., Betz, C., Sarrazin, C., et al. (2012). Effects of fractionated plasma separation and adsorption on survival in patients with acute-on-chronic liver failure. GASTROENTEROLOGY, 142(4), 782–789.
Vancouver
1.
Kribben A, Gerken G, Haag S, Herget-Rosenthal S, Treichel U, Betz C, et al. Effects of fractionated plasma separation and adsorption on survival in patients with acute-on-chronic liver failure. GASTROENTEROLOGY. 2012;142(4):782–9.
MLA
Kribben, Andreas, Guido Gerken, Sebastian Haag, et al. “Effects of Fractionated Plasma Separation and Adsorption on Survival in Patients with Acute-on-chronic Liver Failure.” GASTROENTEROLOGY 142.4 (2012): 782–789. Print.