Extracorporeal
albumin dialysis with the molecular adsorbent recirculating system (MARS) machine is a new supportive intervention for patients with
liver failure. It removes
bilirubin and other
albumin-bound toxins from the patient and has been shown by preliminary studies of
liver failure patients to be beneficial. Our study examines the ability of predialysis molar ratio of
bilirubin to
albumin to predict the decrease of
bilirubin by MARS. We had 5 patients and results from 29 treatments. The results showed a significant correlation between the predialysis molar ratio of
bilirubin (total and conjugated) to
albumin to the reduction in
bilirubin (total and conjugated): R(2) = 0.27 and 0.62 respectively, P <.005 for both. There was no significant correlation with the predialysis molar ratio of unconjugated
bilirubin to
albumin to the reduction in unconjugated
bilirubin. The ratio of change in total
bilirubin (micromol/L) to the predialysis molar ratio of total
bilirubin to
albumin and the ratio of change in conjugated
bilirubin (micromol/L) to the predialysis molar ratio of conjugated
bilirubin to
albumin were 6.2 (+/- 4.2) and 10.8 (+/- 4.3), respectively (mean (+/- SD)). The results enable us to predict the likely reduction in
bilirubin (especially conjugated) after each MARS treatment and also suggest to us that
albumin infusion before MARS treatment may reduce the efficacy of
bilirubin removal. Whether this ratio applies to other
albumin-bound toxins remains open for investigation.