Treatment of patients with chronic liver failure according to disease etiology

Cover Page

Abstract


Aim. Improving the efficiency of treatment of patients with chronic liver failure by optimizing the application of extracorporeal detoxification methods.

Methods. The study included 292 patients with chronic liver failure (188 males and 104 females). The main causes of chronic liver failure were nutritional factor (alcohol abuse), viral liver diseases, and the combination of alcoholic and viral factors. All patients regardless of the disease etiology were divided into groups. Patients in group 1 received standard conservative therapy, aimed at relieving the symptoms of chronic liver failure. Patients in group 2 were additionally administered plasma exchange, in group 3 - PE and high-volume venovenous hemofiltration, and in group 4 - sessions of molecular adsorbent recirculating system (MARS).

Results. Mortality of patients with chronic liver failure on conservative treatment accounted for 84.0% and was 1.5-2.1 times higher than in other groups (53% in plasma exchange group, 52% when using plasma exchange and high-volume venovenous hemofiltration and 40.6% in MARS group), these differences being statistically significant when compared with group 1 (χ2 from of 18.3 to 23.4, p <0.05). Indicators, reflecting the time of 50% mortality of patients with chronic liver failure of different etiology, suggest that in chronic liver failure of alcoholic origin plasma exchange and a combination of plasma exchange and high-volume venovenous hemofiltration are the most effective, and in chronic liver failure of viral and mixed etiology the best results are obtained when using MARS.

Conclusion. The effectiveness of treatment of patients with chronic liver failure depends on the etiology of the disease: in alcoholic chronic liver failure plasma exchange and a combination of plasma exchange and high-volume venovenous hemofiltration are most rational, and in chronic liver failure of viral and mixed etiology MARS sessions are rational.


D E Kutepov

Author for correspondence.
kutepovde@gmail.ru
Clinical Hospital №1 of the Presidential Administration of the Russian Federation; Central State Medical Academy of the Presidential Administration of the Russian Federation

I N Pasechnik

kutepovde@gmail.ru
Clinical Hospital №1 of the Presidential Administration of the Russian Federation

  • Барышникова Н.В., Белоусова Л.Н. Алкогольная болезнь печени: особенности диагностики и лечения. Consil. med. Гастроэнтерология. 2014; (2): 16-18.
  • Бобров А.Н., Павлов А.И., Плюскин С.В. и др. Этиологический профиль циррозов печени с летальным исходом у стационарных больных. Рос. ж. гастроэнтерол., гепатол., колопроктол. 2006; 16 (2): 19-23.
  • Ивашкин В.Т. Болезни печени и желчевыводящих путей. М.: М-Вети. 2002; 416 с.
  • Кутепов Д.Е., Пасечник И.Н., Сальников П.С. Возможности экстракорпоральных методов лечения печёночной недостаточности. Хирургия. 2014; (2): 55-58.
  • Кучеренко В.З. Применение методов статистического анализа для изучения общественного здоровья и здравоохранения. М.: ГЭОТАР-Мед. 2004; 192 с.
  • Пасечник И.Н., Кутепов Д.Е. Печёночная недостаточность: современные методы лечения. М.: МИА. 2009; 240 с.
  • Хазанов А.И., Плюснин С.В., Васильев А.П. и др. Алкогольные и вирусные циррозы печени у стационарных больных (1996-2005 гг.): распространённость и исходы. Рос. ж. гастроэнтерол., гепатол., колопроктол. 2007; 17 (2): 19-27.
  • Хорошилов С.Е., Никулин А.В. Эфферентное лечение критических состояний. Общая реаниматол. 2012; 8 (4): 30-41.
  • Laleman W., Wilmer A., Evenepoel P. et al. Review article: non-biological liver support in liver failure. Aliment. Pharmacol. Ther. 2006; 23: 351-363. doi: 10.1111/j.1365-2036.2006.02765.x.
  • Mitzner S.R., Stange J., Klammt S. et al. Albumin dialysis MARS: knowledge from 10 years of clinical investigation. ASAIO. 2009; 55: 498-502. doi: 10.1097/MAT.0b013e3181b37d86.
  • Stadlbauer V., Davies N.A., Sen S. et al. Artificial liver support systems in the management of complications of cirrhosis. Semin. Liver Dis. 2008; 28 (1): 96-109. doi: 10.1055/s-2008-1040324.
  • Stange J. Extracorporeal liver support. Organogenesis. 2011; 7: 64-73. doi: 10.4161/org.7.1.14069.

Views

Abstract - 34

PDF (Russian) - 45


© 2017 Kutepov D.E., Pasechnik I.N.

Creative Commons License

This work is licensed
under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.