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Critical Care
Published in: Critical Care 6/2006

Open Access 01-12-2006 | Research

Effect of extracorporeal liver support by MARS and Prometheus on serum cytokines in acute-on-chronic liver failure

Authors: Vanessa Stadlbauer, Peter Krisper, Reingard Aigner, Bernd Haditsch, Aleksandra Jung, Carolin Lackner, Rudolf E Stauber

Published in: Critical Care | Issue 6/2006

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Abstract

Introduction

Cytokines are believed to play an important role in acute-on-chronic liver failure (ACLF). Extracorporeal liver support systems may exert beneficial effects in ACLF via removal of cytokines. At present, two systems are commercially available, the Molecular Adsorbent Recirculating System (MARS™) and Fractionated Plasma Separation, Adsorption and Dialysis (Prometheus™). The aim of this study was to compare the effects of MARS and Prometheus treatments on serum cytokine levels and their clearances.

Methods

Eight patients with ACLF underwent alternating treatments with either MARS or Prometheus in a randomized cross-over design. Thirty-four treatments (17 MARS, 17 Prometheus) were available for analysis. Serum cytokines were measured before and after each treatment, and cytokine clearance was calculated from paired arterial and venous samples and effective plasma flow one hour after the start of treatment.

Results

Baseline serum levels of interleukin (IL)-6, IL-8, IL-10, tumor necrosis factor-alpha (TNF-α), and soluble TNF-α receptor 1 were significantly elevated in patients with ACLF. Measurable plasma clearances were detected for all cytokines tested, but no significant changes in serum levels of any cytokine were found after treatments with MARS or Prometheus. In MARS treatments, IL-10 was cleared from plasma more efficiently than IL-6. Clearance of IL-10 was higher in Prometheus than in MARS treatments.

Conclusion

Cytokines are cleared from plasma by both MARS and Prometheus, but neither system is able to change serum cytokine levels. This discrepancy is probably due to a high rate of cytokine production in patients with ACLF.
Appendix
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Metadata
Title
Effect of extracorporeal liver support by MARS and Prometheus on serum cytokines in acute-on-chronic liver failure
Authors
Vanessa Stadlbauer
Peter Krisper
Reingard Aigner
Bernd Haditsch
Aleksandra Jung
Carolin Lackner
Rudolf E Stauber
Publication date
01-12-2006
Publisher
BioMed Central
Published in
Critical Care / Issue 6/2006
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc5119

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