The following is a summary of “Extracorporeal adsorption of protective and toxic bile acids and bilirubin in patients with cholestatic liver dysfunction: a prospective study,” published in the November 2023 issue of Critical Care by Greimel et al.

Researchers performed a prospective study to investigate the effectiveness of Cytosorb^® (CS), a cytokine adsorber, in removing toxic bile acids (BAs) from the blood of critically ill patients with cholestatic liver dysfunction.

They conducted the Cyto-SOVLE study, enrolling 20 intensive care patients with cholestatic liver dysfunction who were undergoing continuous kidney replacement therapy, had a total bilirubin concentration of> 10 mg/dl, and had CS applied to the dialysis circuit. Bilirubin and various BAs were assessed at specified time points (10 min, 1, 3, 6, and 12 h after initiation) before and after CS application. The relative reduction (RR, %) was calculated.

The results showed a median RR for total and conjugated bilirubin of −31.8% and −30.3%, respectively, which decreased to −4.5% and −4.8% after 6 hours. Initial high RRs were observed for toxic BAs GCA (−97.4%), TCA (−94.9%), GCDCA (−82.5%), and TCDCA (−86.0%), decreasing after 6 hours to −32.9%, −32.7%, −12.8%, and −14.3%, respectively. Protective hydrophilic BAs exhibited a comparable RR after initiation (UDCA: −77.7%, GUDCA: −83.0%, TUDCA: −91.3%), dropping after 6 hours to −7.4%, −8.5%, and −12.5%, respectively.

Investigators concluded that cytosorb^® can effectively remove bile acids from the blood of patients with cholestatic liver dysfunction, but its clinical benefits and risks need further evaluation.

Source: annalsofintensivecare.springeropen.com/articles/10.1186/s13613-023-01198-7