Endotoxin Activity Assay for early diagnosis of SIRS in Acute on Chronic Liver Failure patients .
rome, Italy 
9 slide(s) – English – 2011-01-28
Introduction
The aim of our study is the making of early detection of endotoxin in patients with acute liver failure on chronic liver disease (AoCLF) by the test of Endotoxin Activity Assay (EAA) and treated with Polymyxin-B hemoperfusion based (PMX-DHP) and albumin dialysis Molecular Adsorbent Recirculating System (MARS) with follow up at 30 days.
Material and Methods
Since February 2008, ten AoCLF patients with SIRS and EAA positive test (> 0.60) were included in the study. These patients showed similar Model End-Stage Liver Disease (MELD) score of 19-25. Five patients received treatment to remove endotoxins with PMX-DHP and MARS treatment for liver failure(Group A). While the other five patients received MARS treatment only (Group B).
Results
In Group A, two PMX-DHP treatments were performed on 4 patients (mean EAA = 0.66), three treatments for 1 patient (EAA = 0.82) and these 5 patients underwent a mean of 3.5 MARS treatments. After PMX-DHP, the mean level of EAA was 0.31. MARS resulted in improved hemodynamic and liver parameters in association with reduced levels of pro-inflammatory cytokines. At 30 days from the observation, all five patients treated with MARS and PMX-DHP are alive. In Group B, a mean of 7.5 MARS treatments were performed. We observed an improvement in hemodynamic and liver functions with reduced levels of pro-inflammatory cytokines in 4 patients. One patient showed no improvement in clinical status with the development of sepsis and subsequent MOF after 24 days.
Conclusions
The possibility of an early diagnosis with the EAA in AoCLF patients could prevent the progression of sepsis cascade. The use of PMX-DHP and MARS in these patients, could lead to resolution of clinical status in a short time with a particular improvement in hemodynamic parameters.
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