Survival predictors in patients treated with a molecular adsorbent recirculating system

AIM:To identify prognostic factors for survival in patients with liver failure treated with a molecular adsorbent recirculating system(MARS). METHODS:MARS is a liver-assisting device that has been used in the treatment of liver failure to enable native liver recovery,and as a bridge to liver transplantation(LTX).We analyzed the 1-year outcomes of 188 patients treated with MARS,from 2001 to 2007, in an intensive care unit specializing in liver disease. Demographic,clinical and laboratory parameters were recorded before and after each treatment.One-year survival and the number of LTXs were recorded.Logistic regression analysis was performed to determine factors predicting survival. RESULTS:The study included 113 patients with acute liver failure(ALF),62 with acute-on-chronic liver failure(AOCLF),11 with graft failure(GF),and six with miscellaneous liver failure.LTX was performed for 29% of patients with ALF,18% with AOCLF and 55%with GF.The overall 1-year survival rate was 74% for ALF,27% for AOCLF,and 73% for GF.The poorest survival rate,6%,was noted in non-transplanted patients with alcohol-related AOCLF and cirrhosis,whereas,patients with enlarged and steatotic liver had 55% survival.The etiology of liver failure was the most important predictor of survival(P<0.0001).Other prognostic factors were encephalopathy(P=0.001)in paracetamol-related ALF, coagulation factors(P=0.049)and encephalopathy(P=0.064)in non-paracetamol-related toxic ALF,and alanine aminotransferase(P=0.013)and factor V levels(P =0.022)in ALF of unknown etiology. CONCLUSION:The etiology of liver disease was the most important prognostic factor.MARS treatment appears to be ineffective in AOCLF with end-stage cirrhosis without an LTX option.

Cost-utility of molecular adsorbent recirculating system treatment in acute liver failure

AIM:To determine the short-term cost-utility of mo-lecular adsorbent recirculating system(MARS) treatment in acute liver failure(ALF).METHODS:A controlled retrospective study was conducted with 90 ALF patients treated with MARS from 2001 to 2005.Comparisons were made with a historical control group of 17 ALF patients treated from 2000 to 2001 in the same intensive care unit(ICU) specializing in liver diseases.The 3-year outcomes and number of liver transplantations were recorded.All direct liver disease-related medical expenses from 6 mo before to 3 years after ICU treatment were determined for 31 MARS patients and 16 control patients.The health-related quality of life(HRQoL) before MARS treatment was estimated by a panel of ICU doctors and after MARS using a mailed 15D(15-dimensional generic healthrelated quality of life instrument) questionnaire.The HRQoL,cost,and survival data were combined and the incremental cost/quality-adjusted life years(QALYs) was calculated.RESULTS:In surviving ALF patients,the health-related quality of life after treatmeant was generally high and comparable to the age-and gender-matched general Finnish population.Compared to the controls,the average cost per QALY was considerably lower in the MARS group(64 732€ vs 133 858€) within a timeframe of 3.5 years.The incremental cost of standard medical treatment alone compared to MARS was 10 928€,and the incremental number of QALYs gained by MARS was 0.66.CONCLUSION:MARS treatment combined with standard medical treatment for ALF in an ICU setting is more cost-effective than standard medical treatment alone.