Prometheus therapy for the treatment of acute liver failure in patients after cardiac surgery

Komardina, Ekaterina; Yaroustovsky, M.B.; Abramyan, Marina; Plyushch, Marina

doi:10.5114/kitp.2017.72226

Cited by 18 publications

(30 citation statements)

References 23 publications

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“…In the same centre, we reported 15.6% and 13.6% SSI prevalence rates in 2013 and 2014 studies, respectively [ 18 ]. This is comparable to high incidences of SSIs reported across Nigeria [ 19 , 20 , 21 , 22 , 23 ], Ethiopia (19.1%) [ 24 ] and Tanzania (26.0%) [ 25 ]. It was however, higher than figures reported in Egypt [ 26 ], Ghana [ 27 ], England [ 28 ] and USA [ 29 ].…”

Section: Discussionsupporting

confidence: 76%

Occurrence of Surgical Site Infections at a Tertiary Healthcare Facility in Abuja, Nigeria: A Prospective Observational Study

et al. 2018

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Surgical site infection (SSI) is one of the most frequent complications of surgical interventions. Several factors have been identified as major determinants of occurrence of SSIs. The present study determined the occurrence and possible risk factors associated with SSIs at a tertiary healthcare facility in Abuja, Nigeria. All patients scheduled for operation in the hospital during the study period and who consented to participate willingly in the study were observed prospectively for the occurrence of SSI based on criteria stipulated by the United States Centre for Disease Control and Prevention (CDC). Data on sociodemographic characteristics, lifestyle, surgical procedure and co-morbidity were collected into a pre-tested data collection tool and analysed using IBM SPSS Statistics software v.24. Predictors of SSIs were identified using multivariate logistic regression model and p-value less than 0.05 was considered statistically significant. Of the 127 surgical patients that met the inclusion criteria comprising 65 (51.2%) females and 62 (48.8%) males between 1 and 83 years with mean age of 25.64 ± 1.66 years, 35 (27.56%; 95% Confidence Interval (CI): 0.205–0.360) developed SSIs. Prolonged post-operative hospital stays (p < 0.05), class of wound (p < 0.0001) and some comorbid conditions were found to be significantly associated with higher SSI rate. The SSI rate was highest among patients that had Kirschner-wire insertion (75.0%), followed by an unexpectedly high infection rate among patients that had mastectomy (42.9%), while lower percentages (33.3%) were recorded among patients that had exploratory laparotomy and appendicectomy. The overall magnitude of SSIs in this facility is high (27.6%; 95% CI: 0.205–0.360). Several factors were found to be independent predictors of occurrence of SSI. The findings thus highlight the need for improved surveillance of SSIs and review of infection control policies of the hospital.

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Section: Discussionsupporting

confidence: 76%

Occurrence of Surgical Site Infections at a Tertiary Healthcare Facility in Abuja, Nigeria: A Prospective Observational Study

et al. 2018

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“…In previous studies, older age had been identi ed as an independent risk factor of mortality for patients with hyperbilirubinemia after cardiac surgery. [30] In our present study, older age was established a risk factor for in-hospital mortality for patients with hyperbilirubinemia after AAD surgery as well. Aging indicated diminished functional capacity of the liver and added to the cumulative burden in the case of developed severe hyperbilirubinemia.…”

Section: 3risk Factors Of In-hospital and Long-term Mortalitymentioning

confidence: 59%

“…Furthermore, identifying and implementing effective risk reduction strategies is needed. Molecular adsorbent recirculation system, prometheus therapy, fractionated plasma separation and adsorption have shown promise in reducing bilirubin concentration, [30,34] but the ideal timing of blood puri cation initiation after cardiac surgery remains uncertain and further study in this area is needed.…”

Section: 3risk Factors Of In-hospital and Long-term Mortalitymentioning

confidence: 99%

Characteristics and outcomes of Stanford type A aortic dissection patients with severe post-operation hyperbilirubinemia: a retrospective cohort study

Chen

Bai

Zhao

et al. 2020

Preprint

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Abstract Background: Hyperbilirubinemia is one of the common complications after cardiac surgery and is associated with increased mortality. However, to the best of our knowledge, the reports on clinical significance of postoperative severe hyperbilirubinemia in Stanford type A aortic dissection (AAD) patients were limited. Methods: Patients who underwent surgical treatment for AAD in our center between January 2015 and December 2018 were retrospectively screened. In-hospital mortality, long-term mortality, acute kidney injury (AKI), and the requirement of continuous renal replacement therapy (CRRT) were assessed as endpoints. Univariate and multivariate regression models were employed to identify the risk factors of these endpoints. Results: After screening, 271 patients were included in our present study. Of the included patients, 222 (81.9%) experienced postoperative AKI, and 50 (18.5%) received CRRT. The in-hospital mortality was 30.3%. The 1-year, 2-year, and 3-year cumulative mortality were 32.9%, 33.9%, and 35.3%, respectively. Multivariate Logistic regression analysis indicated that age (P < 0.033), AKI stage 3 (P < 0.001), the amount of blood transfusion after surgery (P = 0.019), mean arterial pressure (MAP) in the first postoperative day (P = 0.012), the use of extracorporeal membrane oxygenation (ECMO) (P = 0.02), and the peak total bilirubin (TB) concentration (P = 0.023) were independent risk factors of in-hospital mortality. The optimal cut-off value of peak TB on predicting in-hospital mortality was 121.2 μmol/L. Patients with post-operation TB ≥ 121 μmol/L was associated with worse long-term survival as well. Conclusions: Severe post-operation hyperbilirubinemia is a common clinical situation in patients had AAD repair. In AAD patients with severe post-operation hyperbilirubinemia, older age, lower MAP, increased blood transfusion, stage 3 AKI, the use of ECMO, and the increased peak TB lead to increase in-hospital mortality.

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“…Molecular adsorbent recirculation system, Fig. 3 Long-term survival results of (a) all patients, b patients without AKI and those with stage 1, 2, or 3 AKI, c patients without the use of CRRT and those with CRRT, d patients without the use of ECMO and those with ECMO, e patients with post-operation peak TB ≥ 121.2 μmol/l and those with post-operation peak TB < 121.2 μmol/l prometheus therapy, fractionated plasma separation and adsorption have shown promise in reducing bilirubin concentration [30,34], but the ideal timing of blood purification initiation after cardiac surgery remains uncertain and further study in this area is needed.…”

Section: Risk Factors Of In-hospital and Long-term Mortalitymentioning

confidence: 99%

Characteristics and outcomes of Stanford type A aortic dissection patients with severe post-operation hyperbilirubinemia: a retrospective cohort study

Chen

Bai

Zhao

et al. 2020

J Cardiothorac Surg

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Background: Hyperbilirubinemia is one of the common complications after cardiac surgery and is associated with increased mortality. However, to the best of our knowledge, the reports on clinical significance of postoperative severe hyperbilirubinemia in Stanford type A aortic dissection (AAD) patients were limited. Methods: Patients who underwent surgical treatment for AAD in our center between January 2015 and December 2018 were retrospectively screened. In-hospital mortality, long-term mortality, acute kidney injury (AKI), and the requirement of continuous renal replacement therapy (CRRT) were assessed as endpoints. Univariate and multivariate regression models were employed to identify the risk factors of these endpoints. Results: After screening, 271 patients were included in our present study. Of the included patients, 222 (81.9%) experienced postoperative AKI, and 50 (18.5%) received CRRT. The in-hospital mortality was 30.3%. The 1-year, 2-year, and 3-year cumulative mortality were 32.9, 33.9, and 35.3%, respectively. Multivariate Logistic regression analysis indicated that age (P < 0.033), AKI stage 3 (P < 0.001), the amount of blood transfusion after surgery (P = 0.019), mean arterial pressure (MAP) in the first postoperative day (P = 0.012), the use of extracorporeal membrane oxygenation (ECMO) (P = 0.02), and the peak total bilirubin (TB) concentration (P = 0.023) were independent risk factors of in-hospital mortality. The optimal cutoff value of peak TB on predicting in-hospital mortality was 121.2 μmol/L. Patients with postoperation TB ≥ 121 μmol/L was associated with worse long-term survival as well. Conclusions: Severe post-operation hyperbilirubinemia is a common clinical situation in patients had AAD repair. In AAD patients with severe post-operation hyperbilirubinemia, older age, lower MAP, increased blood transfusion, stage 3 AKI, the use of ECMO, and the increased peak TB lead to increase in-hospital mortality.

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Prometheus therapy for the treatment of acute liver failure in patients after cardiac surgery

Cited by 18 publications

References 23 publications

Occurrence of Surgical Site Infections at a Tertiary Healthcare Facility in Abuja, Nigeria: A Prospective Observational Study

Occurrence of Surgical Site Infections at a Tertiary Healthcare Facility in Abuja, Nigeria: A Prospective Observational Study

Characteristics and outcomes of Stanford type A aortic dissection patients with severe post-operation hyperbilirubinemia: a retrospective cohort study

Characteristics and outcomes of Stanford type A aortic dissection patients with severe post-operation hyperbilirubinemia: a retrospective cohort study

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