ArticleBMC nephrology2025
Artificial liver support with Cytosorb and continuous veno-venous hemodiafiltration versus advanced organ support (ADVOS) for critically ill patients with hyperbilirubinemia and acute-on-chronic liver failure (ACLF).
Article in BMC nephrology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07593638 (Plasma Exchange Half-dose and Extracorporeal Detoxification for ACLF), which is not on this map. Cited by 1 paper.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Plasma Exchange Half-dose and Extracorporeal Detoxification for ACLF
Who cites it
1 citing paper in PubMed.
- Uncovering immune dysfunction in ACLF: Cellular mechanisms, molecular pathways, and therapeutic frontiers.Journal of hepatology · 2026Review
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAs many as 30% of critically ill patients in intensive care units experience acute liver dysfunction with hyperbilirubinemia as a part of multiorgan failure that is associated with poor outcome. This retrospective cohort study was aimed at comparing CytoSorb and ADVOS in terms of bilirubin removal and overall survival among critically ill patients with hyperbilirubinemia ≥ 7 mg/dL.
methodsAt the University Hospital Essen, between January 2021 and March 2024, 71 patients were treated with CytoSorb integrated in a continuous veno-venous hemodiafiltration (CVVHDF) circuit, and 71 patients were treated with ADVOS. Each therapy session lasted 24 h. We separately analyzed the subgroup of patients with acute-on-chronic liver failure (ACLF), in which 31 patients were treated with CytoSorb and 66 patients were treated with ADVOS.
resultsThe first single sessions of both CytoSorb with CVVHDF and ADVOS were associated with a statistically significant decrease in total serum bilirubin levels (Cytosorb, 20 to 14 mg/dL, p < 0.0001; ADVOS, 16 to 14 mg/dL, p < 0.0001), but the percentage bilirubin reduction was more pronounced for CytoSorb treatment (26% vs. 17%, p = 0.0002). The number of days of treatment was similar for both groups (3 vs. 4, p = 0.07). After completion of therapy, serum levels of total bilirubin had decreased significantly; 19.9 to 11.3 mg/dl (p < 0.0001) in the CytoSorb group and 16.3 to 14.0 mg/dL (p = 0.003) in the ADVOS group. The relative bilirubin reduction was significantly higher after application of CytoSorb than after treatment with ADVOS (35% (IQR 19,54) vs. 15% (IQR - 11;54), p < 0.0001). Regarding patients with ACLF, relative reduction of bilirubin after the first session as well as after the completion of liver support was significantly higher among patients who were treated with CVVHDF and CytoSorb than among those patients who received ADVOS. The relative removal of creatinine and urea nitrogen was significantly higher after ADVOS treatment than after CytoSorb with CVVHDF treatment considering all critically ill patients as well as ACLF patients. Seven-day or in-hospital mortality rates were high among critically ill patients and patients with ACLF in both liver support groups.
conclusionsOur results showed that CytoSorb and CVVHDF treatment performed better than ADVOS in bilirubin removal among critically ill patients with hyperbilirubinemia caused by acute liver dysfunction and in the subgroup of patients with ACLF. ADVOS was more efficient in eliminating creatinine and urea nitrogen than was CVVHDF with CytoSorb. Additional prospective randomized controlled trials are warranted to investigate the efficacy of hemoperfusion with CytoSorb for liver disease indications among critically ill patients. CLINICAL TRIAL NUMBER: Not applicable.
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