Factorial analysis by anti-image-matrix (A) and Varimax-matrix rotation (B).

<p>Sufficient suitability of microRNA expression and etiological parameters with coefficients >0.5 (^a suitability criteria). Rotated matrix of components shows a high factorial load by combining microRNA expression and HCC. Factor annotations of initial variables are in bold.</p

Diagnostic performance of microRNA-141 and microRNA-200a.

<p>Receiver operating characteristic (ROC) curve of microRNA-141 (A) and microRNA-200a (B) in three groups (Healthy <i>vs</i>. HCC; Healthy <i>vs</i>. Cirrhosis; HCC <i>vs</i>. Cirrhosis). Area under the curve (AUC) values are presented by the estimate with 95% confidence interval.</p

Baseline patient characteristics: Comparison of MARS and standard medical treatment (SMT).

<p>Baseline patient characteristics: Comparison of MARS and standard medical treatment (SMT).</p

The ΔCt expression level of the five circulating microRNA-200 family members.

<p>ΔCt levels are inversely proportional to the amount of target microRNA in the sample. Asterisks indicate to a significant difference of <i>p</i>< 0.05, respectively.</p

Flow chart displaying the selection procedure and patient numbers.

<p>All patients with moderate to severe hyperbilirubinemia (≥ 6 mg/dL) leading to a hospital admission between January 2009 and June 2015 were screened for acute liver injury or graft dysfunction. All patients in the final cohort received either SMT (41 patients) or SMT and MARS (32 patients).</p

Molecular adsorbent recirculating system (MARS) in acute liver injury and graft dysfunction: Results from a case-control study

<div><p>Background</p><p>The primary therapeutic goals in the treatment of liver injury are to support liver regeneration or bridge the gap to liver transplantation (LT). Molecular adsorbent recirculating system (MARS) therapy has shown beneficial effects for specific symptoms of liver failure; however, general survival advantages have not yet been demonstrated.</p><p>Aim</p><p>We studied the effects of MARS therapy compared to standard medical treatment (SMT) in two patient cohorts: in patients with an acute liver injury and in those with graft dysfunction (GD).</p><p>Methods</p><p>We report on our experience over a 6.5-year period with 73 patients treated with SMT or with SMT and MARS (MARS group). In total, 53 patients suffered from acute liver injury in their native liver without a preexisting liver disease (SMT: n = 31, MARS: n = 22), and 20 patients showed a severe GD after LT (SMT: n = 10, MARS: n = 10).</p><p>Results</p><p>The entire cohort was predominantly characterized by hemodynamically and respiratorily stable patients with a low hepatic encephalopathy (HE) grade and a model of end-stage liver disease (MELD) score of 20.57 (MARS) or 22.51 (SMT, p = 0.555). Within the MARS group, the median number of extracorporeal therapy sessions was four (range = 3–5 sessions). Independent of the underlying etiology, MARS improved the patients’ bilirubin values in the short term compared to SMT alone. In patients with acute liver injury, this response was sustained even after the end of MARS therapy. By contrast, the majority of patients with GD and an initial response to MARS therapy experienced worsened hyperbilirubinemia. No differences in 28-day mortality were observed with respect to acute liver injury (MARS 5.3% (95% CI: 0–15.3); SMT 3.3% (95% CI: 0–9.8), p = 0.754) or GD (MARS 20.0% (95% CI: 0–44.7), SMT 11.1% (95% CI: 0–31.7), p = 0.478).</p><p>Conclusions</p><p>Although it did not improve 28-day mortality, MARS therapy improved the short-term response in patients with acute liver injury as well as in those with GD. In cases of acute hepatic injury, the use of MARS therapy resulted in the sustained stabilization of liver function and improved liver regeneration. A short-term response to MARS may predict the future course of the disease.</p></div

Patients with acute liver injury: Course of bilirubin values and response to MARS treatment in the short term and 2 weeks after the end of MARS therapy.

<p>(A) Course of bilirubin values during the first week of therapy (MARS: 22 patients, SMT: 31 patients). (B) Response classification at day 4 of therapy (No response <i>vs</i>. Partial response <i>vs</i>. Response) was based on the calculated bilirubin reduction and compared to the bilirubin baseline value. (C) Corresponding response classification two weeks after the last MARS session. * Patients with liver transplantation or missing data at follow-up or those who had died were excluded from this analysis (in total, 4 patients).</p

Patients with graft dysfunction: Course of bilirubin values and response to MARS treatment in the short term and 2 weeks after the end of MARS therapy.

<p>(A) Course of bilirubin values during the first week of therapy (MARS: 10 patients, SMT: 10 patients). (B) Response classification at day 4 of therapy (No response <i>vs</i>. Partial response <i>vs</i>. Response) was based on the calculated bilirubin reduction and compared to the bilirubin baseline value. (C) Corresponding response classification two weeks after the last MARS session. * Patients with liver transplantation or missing data at follow-up or those who had died were excluded from this analysis (in total, 4 patients).</p

Short-term response of laboratory parameters.

<p>Short-term response of laboratory parameters.</p

Treatment and outcome data: Comparison of MARS and standard medical treatment (SMT).

<p>Treatment and outcome data: Comparison of MARS and standard medical treatment (SMT).</p