RESUMO
BACKGROUND: Systematic data on clinical outcome in patients with liver failure due to cardiogenic shock are scarce. METHODS: We performed a monocentric retrospective data analysis in 197 cardiogenic shock patients with serum bilirubin levels above 102 µmol/L receiving molecular adsorbent recirculating system (MARS). We assessed clinical outcome, recorded laboratory parameters, and tried to assess risk factors for survival. RESULTS: The median duration of MARS was 87 hours (range, 20-315 hours) during a median time period of 9 days (range, 3-736 days). During MARS, 48 to 75% of patients developed infections and gastrointestinal, respiratory, and neurological complications, respectively. Inhospital mortality was 66% (n = 129). Baseline bilirubin levels were comparable between survivors and non-survivors. During MARS, bilirubin values decreased significantly in survivors but not in non-survivors. Of various clinical and biochemical parameters assessed at baseline, the sepsis-related Organ Failure Assessment score remained the only independent predictor of inhospital mortality. CONCLUSION: Inhospital mortality is still unsatisfyingly high in cardiogenic shock patients with liver failure. Future studies should clarify whether MARS can definitively improve survival in these patients.
