{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T21:35:32Z","timestamp":1792704932046,"version":"4.5.0"},"reference-count":49,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2006,7,19]],"date-time":"2006-07-19T00:00:00Z","timestamp":1153267200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/2.0\/"},{"start":{"date-parts":[[2006,7,19]],"date-time":"2006-07-19T00:00:00Z","timestamp":1153267200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/2.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Crit Care"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Patients with acute-on-chronic liver failure show an aggravated hyperdynamic circulation. We evaluated, in a controlled manner, potential changes in systemic haemodynamics induced by the molecular adsorbent recirculating system (MARS) and the Prometheus system liver detoxification devices in a group of patients with acute-on-chronic liver failure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Eighteen patients (51.2 \u00b1 2.3 years old; Child\u2013Pugh score, 12.5 \u00b1 0.2; Maddrey score, 63.1 \u00b1 5.0; hepatic venous pressure gradient, 17.6 \u00b1 0.9 mmHg) with biopsy-proven alcoholic cirrhosis and superimposed alcoholic hepatitis were either treated with standard medical therapy (SMT) combined with MARS (\n                      <jats:italic>n<\/jats:italic>\n                      = 6) or Prometheus (\n                      <jats:italic>n<\/jats:italic>\n                      = 6) or were treated with SMT alone (\n                      <jats:italic>n<\/jats:italic>\n                      = 6) on three consecutive days (6 hours\/session). Liver tests, systemic haemodynamics and vasoactive substances were determined before and after each session.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Groups were comparable for baseline haemodynamics and levels of vasoactive substances. Both MARS and Prometheus decreased serum bilirubin levels (\n                      <jats:italic>P<\/jats:italic>\n                      &lt; 0.005 versus SMT), the Prometheus device being more effective than MARS (\n                      <jats:italic>P<\/jats:italic>\n                      = 0.002). Only MARS showed significant improvement in the mean arterial pressure (\u0394change, +9 \u00b1 2.4 mmHg versus -0.3 \u00b1 2.4 mmHg with Prometheus and -5.2 \u00b1 2.1 mmHg with SMT,\n                      <jats:italic>P<\/jats:italic>\n                      &lt; 0.05) and in the systemic vascular resistance index (\u0394change, +131.5 \u00b1 46.2 dyne.s\/cm\n                      <jats:sup>5<\/jats:sup>\n                      \/m\n                      <jats:sup>2<\/jats:sup>\n                      versus -92.8 \u00b1 85.2 dyne.s\/cm\n                      <jats:sup>5<\/jats:sup>\n                      \/m\n                      <jats:sup>2<\/jats:sup>\n                      with Prometheus and -30.7 \u00b1 32.5 dyne.s\/cm\n                      <jats:sup>5<\/jats:sup>\n                      \/m\n                      <jats:sup>2<\/jats:sup>\n                      with SMT;\n                      <jats:italic>P<\/jats:italic>\n                      &lt; 0.05), while the cardiac index and central filling remained constant. This circulatory improvement in the MARS group was paralleled by a decrease in plasma renin activity (\n                      <jats:italic>P<\/jats:italic>\n                      &lt; 0.05), aldosterone (\n                      <jats:italic>P<\/jats:italic>\n                      &lt; 0.03), norepinephrine (\n                      <jats:italic>P<\/jats:italic>\n                      &lt; 0.05), vasopressin (\n                      <jats:italic>P<\/jats:italic>\n                      = 0.005) and nitrate\/nitrite levels (\n                      <jats:italic>P<\/jats:italic>\n                      &lt; 0.02).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The MARS device, and not the Prometheus device, significantly attenuates the hyperdynamic circulation in acute-on-chronic liver failure, presumably by a difference in removal rate of certain vasoactive substances. These findings suggest conspicuous conceptual differences among the albumin dialysis devices.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/cc4985","type":"journal-article","created":{"date-parts":[[2006,7,21]],"date-time":"2006-07-21T16:09:28Z","timestamp":1153498168000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":205,"title":["Effect of the molecular adsorbent recirculating system and Prometheus devices on systemic haemodynamics and vasoactive agents in patients with acute-on-chronic alcoholic liver failure"],"prefix":"10.1186","volume":"10","author":[{"given":"Wim","family":"Laleman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Wilmer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pieter","family":"Evenepoel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingrid Vander","family":"Elst","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcel","family":"Zeegers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zahur","family":"Zaman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris","family":"Verslype","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johan","family":"Fevery","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederik","family":"Nevens","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2006,7,19]]},"reference":[{"key":"4506_CR1","doi-asserted-by":"publisher","first-page":"252","DOI":"10.1159\/000047017","volume":"20","author":"R Jalan","year":"2002","unstructured":"Jalan R, Williams R: Acute-on-chronic liver failure: pathophysiological basis of therapeutic options.\n                           Blood Purif 2002, 20: 252-261. 10.1159\/000047017","journal-title":"Blood Purif"},{"key":"4506_CR2","doi-asserted-by":"publisher","first-page":"468","DOI":"10.1111\/j.1572-0241.2005.40864.x","volume":"100","author":"S Sen","year":"2005","unstructured":"Sen S, Williams R, Jalan R: Emerging indications for albumin dialysis.\n                           Am J Gastroenterol 2005, 100: 468-475. 10.1111\/j.1572-0241.2005.40864.x","journal-title":"Am J Gastroenterol"},{"key":"4506_CR3","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1111\/j.1365-2036.2006.02765.x","volume":"23","author":"W Laleman","year":"2006","unstructured":"Laleman W, Wilmer A, Evenepoel P, Verslype C, Fevery J, Nevens F: Review article: non-biological liver support in liver failure.\n                           Aliment Pharmacol Ther 2006, 23: 351-363. 10.1111\/j.1365-2036.2006.02765.x","journal-title":"Aliment Pharmacol Ther"},{"key":"4506_CR4","first-page":"17","volume-title":"Portal Hypertension: Pathophysiology and Treatment","author":"RJ Groszmann","year":"1994","unstructured":"Groszmann RJ: Vasodilatation and hyperdynamic circulatory state in chronic liver diseases. 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