REMOVAL OF ENDOTOXIN AND CYTOKINES BY PLASMA-EXCHANGE IN PATIENTS WITH ACUTE HEPATIC-FAILURE

Objectives: To compare the circulating concentrations of endotoxin and cytokines in patients with fulminant hepatitis and patients with the severe form of acute hepatitis, and to assess the effects of plasma ex change on the circulating concentrations of these inflammatory mediato rs in patients with acute hepatic failure, Design: Prospective, consec utive entry study of patients meeting fulminant hepatitis criteria and the severe form of acute hepatitis criteria. Setting: University hosp ital, intensive care unit. Patients: Five patients with fulminant hepa titis, eight patients with the severe form of acute hepatitis, two pat ients with acute-on-chronic hepatic failure, and one patient with post operative hepatic failure. Interventions: Plasma endotoxin, serum tumo r necrosis factor (TNF)-alpha, interleukin (IL)-1 beta, and IL-6 were determined on admission in five patients with fulminant hepatitis and eight patients with the severe form of acute hepatitis. Circulating co ncentrations of the inflammatory mediators were measured before and af ter a single course of plasma exchange in eight patients with acute li ver failure, including five patients with fulminant hepatitis, two pat ients with acute-on-chronic hepatic failure, and one patient with post operative hepatic failure. Measurements and Main Results: TNF-alpha an d IL-6 in patients with fulminant hepatitis were significantly higher than in patients with the severe form of acute hepatitis, whereas endo toxin concentrations did not differ between patients with fulminant he patitis or the severe form of acute hepatitis. IL-1 beta was not detec table in patients with either fulminant hepatitis or the severe form o f acute hepatitis. Plasma endotoxin concentrations decreased immediate ly after plasma exchange. Serum concentrations of TNF-alpha and IL-6 w ere significantly lower after plasma exchange than before plasma excha nge. Conclusion: TNF-alpha and IL-6 may be important in the pathogenes is of the clinical symptoms that differentiate fulminant hepatitis fro m the severe form of acute hepatitis, and plasma exchange removes thes e inflammatory mediators from the circulation of patients with severe liver disease.