The Value of Hemoperfusion Using Charcod Tilters in Treatment of Hepatic Encephalopathy and Hepatorend Syndrome

Abstract

Introduction: Renewed interest has developed in old and new methods for an extracorporeal approach to the treatment of acute and chronic liver failure. Reasoning that the main problem in liver failure is the build-up of toxic compounds in the blood, we aimed in this study at evaluating charcoal hemoperfusion in treatment of patients having liver failure with hepatic encephalopathy and hepatorenal syndrome. Subjects and Methods: This study included 32 patients with hepatocellular failure and hepatorenal syndrome. Patients were divided into 2 groups; Group (I) included 22 patients who had hepatic encephalopathy and hepatorenal syndrome and underwent haemoperfusion treatment for one, two or three sessions of 4 hours duration each, as well as the standard measures for treatment of .liver failure and hepatorenal syndrome in the Intensive Care Unit. Group (II) included 10 patients who had hepatic encephalopathy and hepatorenal syndrome and they received the standard measures for treatment of liver failure and hepatorenal syndrome in the Intensive Care Unit and they did not undergo haemoperfusion as a line of treatment. Results: By comparing results of both groups we found that; Hemoglobin percent and platelets counts showed significant marked decrease in patients of group (I) after haemoperfusion (P<0.001). Total proteins level and serum albumin were significaly markedly decreased. Prothrombin concentration in patients of both groups and these findings were statistically higher in significance in group (I) than in group (II). Kidney function tests showed significant significant reduction in serum urea and creatinine in group (I) after hemoperfusion. Conscious level and grade of hepatic encephalopathy; improved in twelve patients corresponding to 3 patients in group (II) (>0.05 NS). Mortality rate was (90.0%) in those patients due to the late, complicated, serious conditions of our patients who had end-stage hepatocellular failure complicated with hepatic encephalopathy, cerebral oedema and hepatorenal syndrome. Conclusion: So we can conclude that poor prognosis still accompany liver failure when associated with hepatic encephalopathy, cerebral oedema, renal failure (HRS) or respiratory or circulatory failure.