Acute-On-Chronic Liver Failure
Conditions
Brief summary
ALF (ALF) is defined by three criteria: (1) rapid development of hepatocellular dysfunction (jaundice, coagulopathy), (2) hepatic encephalopathy, and (3) absence of a prior history of liver disease. Interval between onset of acute hepatic injury (jaundice) and onset of liver failure (encephalopathy with or without coagulopathy) in such patients (icterus-encephalopathy interval; IEI) has been described to be between 4 weeks (Indian definition) to 24 weeks (AASLD-ALF study group). Further, due to the diverse natural course, ALF has been sub-classified as hyperacute (IEI ≤ 7 day), acute (IEI ≤ 4 weeks) and sub-acute ALF (IEI ≥ 5 week to ≤12 weeks) by British authors.
Detailed description
Since the 1960s, Liver Transplantation (LT) has emerged as a cornerstone intervention to cure liver failure. Mortality in patients with liver failure who cannot be rescued with Liver Transplantation remains high despite improvements in supportive care. Artificial Liver Support System (ALSS) in ALF aim to remove excess inflammatory cytokines and attenuate inflammatory response, to remove albumin-bound and water-soluble toxins, to restore and preserve hepatic function and mitigate or limit the progression of multiorgan failure while hepatic recovery or liver transplant occurs. ALSS may also provide benefit in instances where LT is contraindicated. The following beneficial effects have been documented with ALSS in ALF patients: improvement of jaundice, amelioration of hemodynamic instability, improvement of hepatic encephalopathy, SOFA score and survival. HA 330-II is a broad-spectrum adsorbent made of neutral macroporous resin, removes toxins such as Inflammatory mediators (IL-1, IL-6, IL-8 & TNF-α) along with hepatic toxins such as phenol, mercaptan, aromatic amino acids, false neurotransmitters and indirectly ammonia by improving liver function recovery. However, this indirect ammonia removal with HA 330-II is insignificant. By removing excess inflammatory cytokines and attenuating uncontrolled immune response, HA 330-II prevents worsening of encephalopathy, improves liver function recovery and improves prognosis.
Interventions
DEVICEHA 330-II
One unit for 2-4 hours treatment, for 3 consecutive days
SMT as per patients requirement- Management of cerebral edema/intracranial hypertension: prophylactic antibiotics, administration of mannitol or 3% saline for severe elevation of Intra Cranial Pressure, volume replacement and pressor support (noradrenaline, doubutamine, dopamine) as needed, NAC and correction of metabolic parameters.
Sponsors
Asian Institute of Gastroenterology, India
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Hemoperfusion treatment with HA 330-II, one unit for 2-4 hours treatment, for 3 consecutive days along with standard medical treatment (SMT) as per patients requirement.
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
• Acute Liver Failure patients with SIRS and Hepatic Encephalopathy, without hyperbilirubinemia.
Exclusion criteria
* Patients with age less than 18 years or more than 65 years * Extremely moribund patients with an expected life expectancy of less than 24 hours or with poor prognosis * With poor blood clotting function and PTA \<30%. * Active Bleed * Chronic heart, lung or kidney disease * Malignant tumors including liver cancer * Past history of organ transplantation
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Efficacy of HA 330-II to prolong liver-transplantation free survival. | Up to 30 Days | The length of survival time after first hemofiltration treatment during the follow-up period. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Systemic inflammatory response syndrome (SIRS) score. | Up to 7 Days, post hemofiltration | To assess efficacy of treatment. |
| Change in Acute Physiology and Chronic Health Evaluation (APACHE-II) score. | Up to 7 Days, post hemofiltration | To assess efficacy of treatment. |
| Change in sequential organ failure assessment (SOFA) score. | Up to 7 Days, post hemofiltration | To assess efficacy of treatment. |
| Change in chronic liver failure-sequential organ failure assessment (CLIF-SOFA) score. | Up to 7 Days, post hemofiltration | To assess efficacy of treatment. |
Countries
India
Contacts
Primary ContactMithun Sharma, MD, DM
Outcome results
None listed