Feasibility and Safety of Cytosorb Application in Patients With Acute Liver Failure

Acute liver failure (ALF) is a rare, life-threatening condition with high mortality and limited therapeutic options beyond liver transplantation. Cytosorb adsorber can be easily applied to continuous renal replacement therapy (CRRT) and potentially support liver function by removing bilirubin and cytokines.

This retrospective single-centre study included all ALF patients admitted to the intensive care unit (ICU) at the Division of Gastroenterology and Hepatology of the Vienna General Hospital from 2012 to 2025 receiving CRRT.

Twenty-eight ALF patients (median SOFA 11, SAPS II 43) were included, with high incidences of vasopressor use (82.1%) and invasive ventilation (85.7%). Fourteen received adjunctive Cytosorb therapy. Complications (hemodynamic instability, citrate accumulation, bleeding, hypofibrinogenemia, thrombocytopenia) were similar in patients with or without Cytosorb. Bilirubin levels significantly decreased after Cytosorb initiation (from 20.85 to 12.32 mg/dL at 24 h, and to 9.46 mg/dL after treatment; p < 0.001), GGT, ALAT, and platelets also declined post-treatment. Cytosorb patients had lower SAPS II scores (median: 38.5 vs. 45.5, p = 0.039), were more often listed for HU-LTx (92.9% vs. 42.9%, p = 0.005), and had higher transplantation rates (64.3% vs. 28.6%, p = 0.058). Therefore, ICU survival (71.4% vs. 42.9%; p = 0.127) and 6-month survival (71.4% vs. 28.6%; p = 0.023) were higher in the Cytosorb group.

Cytosorb appeared to be a feasible and well-tolerated blood purification tool with potential beneficial effects in ALF patients. Improved survival with Cytosorb likely reflects confounding by patient selection and higher HU-LTx rates. Prospective studies are warranted to clarify the clinical impact of adjunctive Cytosorb therapy in ALF patients.