Category Ranking
98%
Total Visits
921
Avg Visit Duration
2 minutes
Citations
20
Article Abstract
Background And Aims: Treatment of patients with acute on chronic liver failure (ACLF) admitted to the ICU is very limited. The aim of this pilot study was to evaluate the efficiency on liver function and safety of therapeutic plasma exchange (TPE) in critically ill cirrhotic patients admitted with ACLF in a liver ICU.
Methods: This is a prospective cohort of patients with ACLF grade > 2 treated by TPE admitted to the ICU that was matched to a control group. TPE was performed using a plasma filter (TPE2000, BAXTER®) on a CRRT machine (Prismaflex®, Baxter®). Ratio and type of fluid replacement were 50 % with 5 % albumin solution followed by 50 % with fresh frozen plasma.
Results: Seven patients with a mean age of 50.6 ± 7.8 years (all males) and 14 controls matched to age, sex, etiology and cause of decompensation were recruited. At ICU admission, mean MELD score was 39.1 ± 2.7, mean SOFA score was 11.6 ± 5.2 and mean CLIF SOFA score was 12.9 ± 2.6. The grade of ACLF was 3 for 3 patients (42.9 %) and 2 for 4 patients (57.1 %). The TPE group had significantly higher levels of bilirubin (392.3 ± 117.1μmol/l vs. 219 ± 185μmol/l , p = 0.04), and INR values (5.7 ± 3.4 vs. 3.5 ± 0.9, p < 0.005) compared to the control group. Patient survival was respectively 28.6 % and 14.3 % at 30 and 90 days in the TPE group and 35.7 % and 7.14 % in the control group respectively (HR: 1 (95 % CI 0.19- 5.2; p = 1). One patient in the TPE group had a liver transplantation 13 days after admission to ICU and is still alive and none in the control group. Two (28.6 %) patients died from complications related to the double lumen catheter used for TPE.
Conclusion: This pilot study of TPE in patients with ACLF grade 2 and 3 showed a marked but transient improvement in liver function tests. TPE worth to be evaluated in large trials in ACLF patients, with a liver transplant project, and less organ failure.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/j.clinre.2023.102206 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Associations between element mixtures and biomarkers of pathophysiologic pathways related to autism spectrum disorder.
J Trace Elem Med Biol
September 2025
Department of Neurology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China. Electronic address:
Objective: We previously documented that exposure to a spectrum of elements is associated with autism spectrum disorder (ASD). However, there is a lack of mechanistic understanding as to how elemental mixtures contribute to the ASD development.
Materials And Methods: Serum and urinary concentrations of 26 elements and six biomarkers of ASD-relevant pathophysiologic pathways including serum HIPK 2, serum p53 protein, urine malondialdehyde (MDA), urine 8-OHdG, serum melatonin, and urine carnitine, were measured in 21 ASD cases and 21 age-matched healthy controls of children aged 6-12 years.
A Self-Guided Digital Mental Health Promotion Service Targeting Young People: Protocol for a Randomized Controlled Trial.
JMIR Res Protoc
September 2025
National Institute of Public Health, University of Southern Denmark, Copenhagen K, Denmark.
Background: The high and increasing rate of poor mental health among young people is a matter of global concern. Experiencing poor mental health during this formative stage of life can adversely impact interpersonal relationships, academic and professional performance, and future health and well-being if not addressed early. However, only a few of those in need seek help.
View Article and Find Full Text PDFStrong Families Start at Home/Familias Fuertes Comienzan en Casa-Improving Child Diet Quality and Parental Feeding Practices: Protocol for a Randomized Controlled Trial.
JMIR Res Protoc
September 2025
Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, United States.
Background: Children in the United States have poor diet quality, increasing their risk for chronic disease burden later in life. Caregivers' feeding behaviors are a critical factor in shaping lifelong dietary habits. The Strong Families Start at Home/Familias Fuertes Comienzan en Casa (SFSH) was a 6-month, home-based, pilot randomized-controlled feasibility trial that aimed to improve the diet quality of 2-5-year-old children and promote positive parental feeding practices among a predominantly Hispanic/Latine sample.
View Article and Find Full Text PDFImplementing Social Media Strategies in Community-Partnered HIV Research: Practical Considerations From 3 Ongoing Studies.
JMIR Public Health Surveill
September 2025
Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, United States.
Background: In recent years, social media has emerged as a pivotal tool in implementation science efforts to address the HIV epidemic. Engaging community partners is essential to ensure the successful and equitable implementation of social media strategies. There is a notable lack of scholarship addressing the operational considerations for studies using social media strategies in community-partnered HIV research.
View Article and Find Full Text PDFNocturnal Oxygen Therapy for Central Sleep Apnea in Patients with Heart Failure: A Multi-site, Double-blind, Sham-controlled Randomized Clinical Trial (LOFT-HF).
Ann Am Thorac Soc
September 2025
Brigham and Women's Hospital, Division of Sleep and Circadian Disorders, Boston, Massachusetts, United States.
Rationale: There are insufficient data to inform the management of central sleep apnea (CSA) in patients with heart failure (HF) with reduced ejection fraction (HFrEF). Nocturnal oxygen therapy (NOT) has been postulated to benefit CSA patients with HFrEF, but has not been rigorously studied. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.
View Article and Find Full Text PDF