Related Experiment Video

Updated: Jun 1, 2026

Laparoscopic Anatomic S7+S8d Resection Preserving Inferior Right Hepatic Vein and S6 with Right Hepatic Vein Transection
06:00

Laparoscopic Anatomic S7+S8d Resection Preserving Inferior Right Hepatic Vein and S6 with Right Hepatic Vein Transection

Published on: December 30, 2025

Management of sepsis during MARS treatment in acute on chronic liver failure

G Novelli1, V Morabito, F Pugliese

  • 1Dipartimento P. Stefanini, Chirurgia Generale e Trapianti d'Organo, Sapienza Università di Roma, Rome, Italy. novelligilnardo@virgilio.it

Transplantation Proceedings
|May 31, 2011
PubMed
Abstract

Insights

Early endotoxin detection using EAA in acute liver failure patients treated with polymyxin-B hemoperfusion (PMX-DHP) and MARS dialysis improved outcomes. All patients receiving PMX-DHP and MARS survived 30 days, showing reduced inflammatory markers.

Area of Science:

  • Hepatology
  • Critical Care Medicine
  • Immunology

Background:

  • Acute liver failure superimposed on chronic liver disease (AoCLF) presents significant challenges.
  • Systemic inflammatory response syndrome (SIRS) and suspected infection are common complications.
  • Early endotoxin detection is crucial for timely intervention.

Purpose of the Study:

  • To evaluate the 30-day outcomes of early endotoxin detection using the endotoxin activity assay (EAA).
  • To assess the efficacy of polymyxin-B hemoperfusion (PMX-DHP) combined with albumin dialysis (MARS) in AoCLF patients.
  • To investigate the impact of combined therapy on inflammatory markers and clinical status.

Main Methods:

  • 10 AoCLF patients with SIRS and positive EAA (>0.60) were studied.
  • Patients were divided into two groups: Group A (PMX-DHP + MARS) and Group B (MARS only).
  • EAA, MELD scores, and encephalopathy grades were assessed; inflammatory markers (lactate, IL-6, TNF-α) were monitored.

Main Results:

  • The combined PMX-DHP and MARS therapy (Group A) resulted in a median EAA reduction to 0.42.
  • Significant improvements in liver and kidney function, lactate, IL-6, and TNF-α were observed in Group A.
  • All 5 patients in Group A survived the 30-day follow-up, while one patient in Group B developed sepsis and multiorgan failure.

Conclusions:

  • Early EAA diagnosis in AoCLF patients can help prevent sepsis progression.
  • Combined PMX-DHP and MARS treatment shows promise for rapid clinical improvement in AoCLF patients.
  • Extracorporeal therapies effectively reduce endotoxin levels and inflammatory cytokines.

More Related Videos

Three-Dimensional Collagen Matrix Scaffold Implantation as a Liver Regeneration Strategy05:20

Three-Dimensional Collagen Matrix Scaffold Implantation as a Liver Regeneration Strategy

Published on: June 29, 2021

Related Concept Videos

Esophageal Varices-II: Clinical Features and Management01:28

Esophageal Varices-II: Clinical Features and Management

Esophageal varices often manifest as gastrointestinal bleeding episodes, presenting symptoms like hematemesis (vomiting of blood), hematochezia (passing fresh blood via the rectum), and melena (black, tarry stools). Other signs can include weight loss, anorexia, abdominal discomfort, jaundice, pruritus, altered mental status, and muscle cramps.
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol abuse, or...
Acute Pancreatitis II: Clinical Manifestations and Management01:30

Acute Pancreatitis II: Clinical Manifestations and Management

Acute pancreatitis presents a complex medical emergency characterized by rapid onset inflammation of the pancreas, demanding timely diagnosis and management to prevent complications. The condition primarily manifests through severe upper abdominal pain that often radiates to the back. This pain intensifies following the consumption of fatty foods. Accompanying symptoms such as nausea, vomiting, abdominal distention, fever, dyspnea, cyanosis, and jaundice can vary in intensity but significantly...
Acute Respiratory Failure-V01:29

Acute Respiratory Failure-V

The treatment for acute respiratory failure varies based on factors like the underlying cause, overall health, and severity. A collaborative healthcare team is essential for early detection, often through arterial blood gas analysis. Identifying the cause is the primary goal, with treatment strategies adjusted for ventilation/perfusion (V/Q) mismatch, shunting, or diffusion impairment.
Ensure that patients are monitored continuously for their response to therapy, including changes in...
Acute Pyelonephritis II: Diagnostic Studies and Management01:28

Acute Pyelonephritis II: Diagnostic Studies and Management

Introduction:For diagnosing acute pyelonephritis, a comprehensive patient history is collected to identify symptoms such as dysuria, frequent or urgent urination, flank pain, or costovertebral angle (CVA) tenderness that may suggest a kidney infection.Physical ExaminationDuring the physical examination, CVA tenderness is assessed. This involves gentle percussion over the costovertebral angle, where tenderness often indicates a kidney infection.Diagnostic TestsUrinalysis: Used to identify white...
Chronic Pancreatitis II: Collaborative Care01:29

Chronic Pancreatitis II: Collaborative Care

The management of chronic pancreatitis is multifaceted, involving a comprehensive approach that includes thorough assessment, diagnostic testing, and a variety of management strategies.
Assessment:
Acute Kidney Injury VI: Nursing Management01:22

Acute Kidney Injury VI: Nursing Management

Acute Kidney Injury (AKI) results in an inability to maintain fluid, electrolyte, and acid-base balance. Effective nursing management is critical in improving patient outcomes and includes comprehensive patient assessment and targeted interventions.Comprehensive Patient AssessmentA detailed history collection is essential, focusing on any recent infections, nephrotoxic medication use, or chronic conditions such as hypertension and diabetes that may contribute to AKI. During the physical...