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[Extracorporeal therapies in hepatic diseases]
D Jarczak1, G Braun2, V Fuhrmann3
1Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland.
Summary
Extracorporeal therapies, including artificial liver support and plasma exchange, are crucial for critically ill patients with liver failure, showing improved outcomes. Further research is needed to optimize their use and identify futility criteria.
Area of Science:
- Hepatology
- Critical Care Medicine
- Nephrology
Background:
- Hepatic dysfunction affects up to 20% of critically ill patients, increasing morbidity and mortality.
- Acute and acute-on-chronic liver failure present diverse etiologies and organ failure complications.
- Extracorporeal procedures are vital in managing liver diseases, impacting patient outcomes.
Purpose of the Study:
- To review the role and efficacy of various extracorporeal therapies in critically ill patients with hepatic failure.
- To compare the outcomes of different extracorporeal procedures in liver disease management.
- To identify areas for future research in extracorporeal therapy for liver failure.
Main Methods:
- Review of randomized controlled studies and retrospective case series on extracorporeal therapies.
- Analysis of artificial and bioartificial liver support, plasma exchange, and renal replacement therapies.
- Evaluation of safety, efficacy, and survival benefits in critically ill patients with liver diseases.
Main Results:
- Artificial liver support and plasma exchange demonstrated safety, improving hepatic encephalopathy and hemodynamics, with some trials showing survival benefits.
- Renal replacement therapy in liver cirrhosis patients was associated with high mortality rates in retrospective studies.
- Extracorporeal therapies are recognized as a cornerstone in managing critically ill patients with hepatic failure.
Conclusions:
- Extracorporeal therapies are essential for critically ill patients with hepatic failure.
- Future studies should focus on optimal timing, duration, and futility criteria for these interventions.
- Continued research is necessary to refine the application of extracorporeal therapies in liver failure management.
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