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Acute decompensation of chronically stable alcoholic liver disease (ALD) is the most common cause of terminal liver failure in developed countries. Molecular adsorbent recirculation system (MARS) is increasingly used as artificial liver support to facilitate spontaneous organ recovery. However, the experience to date and the evidence to justify this therapeutic strategy in acutely decompensated ALD are still insufficient. We report our clinical experience with MARS in 14 patients with acutely decompensated ALD (6 male Gpt/L; P ϭ 0.004). In contrast, MARS failed to improve daily urine output (P ϭ 0.846), ammonia levels (P ϭ 0.340), or thromboplastin time (P ϭ 0.775). Only 3 patients survived the hospital stay (mortality 78.6%). Although MARS improved laboratory parameters of hepatic detoxification and renal function in patients with acutely decompensated ALD, the patients' mortality remained unsatisfactorily high. Our experience does not support the indiscriminative use of MARS in acutely decompensated ALD without further controlled studies.

A 53-year-old man fell ill with myalgia, an haemorrhagic diathesis, fever, renal failure and circulatory shock. Anaemia, thrombocytopenia and lymphadenopathy quickly developed, and he died after 13 days of bronchopneumonia in treatment-resistant cardiocirculatory failure. The underlying cause of the illness, in the two weeks during which he received intensive treatment with prolonged mechanical ventilation, haemodialysis, administration of clotting factors and blood derivatives as well as high doses of cortisone and antibiotics, remained uncertain. Histological examination of lymph-node biopsy and bone-marrow obtained at autopsy demonstrated massive increase in the number of benign haemophagocytic histiocytes, which--together with the clinical picture--gave the diagnosis of an infection-associated haemophagocytic syndrome. This is a rare disease and apparently the expression of an abnormal immune reaction with potentially reversible phagocytosis of the body's own blood cells after preceding infection, often a viral one.