High-Volume Plasma Exchange Versus Standard Medical Treatment in Patients With Acute Liver Failure

NCT ID: NCT02718079

Last Updated: 2019-11-20

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

40 participants

Study Classification

INTERVENTIONAL

Study Start Date

2016-12-30

Study Completion Date

2018-10-18

Brief Summary

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The study will be conducted on patients admitted to Department of Hepatology from Jan 2016 to Jan 2018 at Institute of Liver \& Biliary Sciences, New Delhi. Study group will comprise of patients with acute liver failure (ALF) who have no option for liver transplant (due to any reason) or have contraindications for liver transplant or have no prospective living donor and will be assessed for enrollment in the trial.

Detailed Description

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Conditions

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Acute Liver Failure

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Standard medical therapy with Plasma Exchange

Plasma Exchange will be performed for consecutive days. Standard medical therapy included as per requirement,management of cerebral edema/intracranial hypertension: transfer to ICU,prophylactic antibiotics, intubation of trachea (as required),administration of mannitol or 3% saline for severe elevation of Intra Cranial Pressure,volume replacement and pressor support (norepinephrine, vasopressin) as needed, NAC, correction of metabolic parameters and nutrition.

Group Type EXPERIMENTAL

Plasma Exchange

Intervention Type BIOLOGICAL

Management of cerebral edema/intracranial hypertension:

Intervention Type OTHER

Transfer to Intensive Care Unit

Intervention Type OTHER

Prophylactic Antibiotics

Intervention Type DRUG

Intubation of trachea

Intervention Type OTHER

Administration of mannitol or 3% saline for severe elevation of Intra Cranial Pressure

Intervention Type OTHER

Volume Replacement

Intervention Type OTHER

Pressor Support

Intervention Type OTHER

N-acetyl-L-cysteine

Intervention Type DRUG

Correction of metabolic parameters

Intervention Type OTHER

Correction of nutrition

Intervention Type DIETARY_SUPPLEMENT

Standard medical therapy alone

Standard medical therapy included as per requirement,management of cerebral edema/intracranial hypertension: transfer to ICU,prophylactic antibiotics, intubation of trachea (as required),administration of mannitol or 3% saline for severe elevation of Intra Cranial Pressure,volume replacement and pressor support (norepinephrine, vasopressin) as needed, NAC, correction of metabolic parameters and nutrition.

Group Type ACTIVE_COMPARATOR

Management of cerebral edema/intracranial hypertension:

Intervention Type OTHER

Transfer to Intensive Care Unit

Intervention Type OTHER

Prophylactic Antibiotics

Intervention Type DRUG

Intubation of trachea

Intervention Type OTHER

Administration of mannitol or 3% saline for severe elevation of Intra Cranial Pressure

Intervention Type OTHER

Volume Replacement

Intervention Type OTHER

Pressor Support

Intervention Type OTHER

N-acetyl-L-cysteine

Intervention Type DRUG

Correction of metabolic parameters

Intervention Type OTHER

Correction of nutrition

Intervention Type DIETARY_SUPPLEMENT

Interventions

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Plasma Exchange

Intervention Type BIOLOGICAL

Management of cerebral edema/intracranial hypertension:

Intervention Type OTHER

Transfer to Intensive Care Unit

Intervention Type OTHER

Prophylactic Antibiotics

Intervention Type DRUG

Intubation of trachea

Intervention Type OTHER

Administration of mannitol or 3% saline for severe elevation of Intra Cranial Pressure

Intervention Type OTHER

Volume Replacement

Intervention Type OTHER

Pressor Support

Intervention Type OTHER

N-acetyl-L-cysteine

Intervention Type DRUG

Correction of metabolic parameters

Intervention Type OTHER

Correction of nutrition

Intervention Type DIETARY_SUPPLEMENT

Eligibility Criteria

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Inclusion Criteria

* Patients with acute liver failure defined as : Patients with jaundice which is complicated by encephalopathy and coagulopathy within 4 weeks of the onset of jaundice and without underlying chronic liver disease.

Exclusion Criteria

* Age \<12 or \> 75 years
* Hepato-Cellular Carcinoma
* Active untreated Sepsis/DIC
* Any evidence of active bleed secondary to coagulopathy
* Hemodynamic instability requiring high dose of Vasopressors
* Coma of non-hepatic origin.
* Pregnancy
* Comorbidities associated with poor outcome (Extrahepatic neoplasia, severe cardiopulmonary disease defined by a New York Heart Association score \>3, or oxygen/steroid-dependent chronic obstructive pulmonary disease).
* Patients being taken up for liver transplant
* Refusal to participate in the study.
Minimum Eligible Age

12 Years

Maximum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Institute of Liver and Biliary Sciences, India

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Dr Rakhi Maiwall, DM

Role: PRINCIPAL_INVESTIGATOR

Institute of Liver and Biliary Sciences

Locations

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Institute of liver and Biliary Sciences

New Delhi, National Capital Territory of Delhi, India

Site Status

Countries

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India

References

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Maiwall R, Bajpai M, Singh A, Agarwal T, Kumar G, Bharadwaj A, Nautiyal N, Tevethia H, Jagdish RK, Vijayaraghavan R, Choudhury A, Mathur RP, Hidam A, Pati NT, Sharma MK, Kumar A, Sarin SK. Standard-Volume Plasma Exchange Improves Outcomes in Patients With Acute Liver Failure: A Randomized Controlled Trial. Clin Gastroenterol Hepatol. 2022 Apr;20(4):e831-e854. doi: 10.1016/j.cgh.2021.01.036. Epub 2021 Jan 29.

Reference Type DERIVED
PMID: 33524593 (View on PubMed)

Other Identifiers

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ILBS-ALF-03

Identifier Type: -

Identifier Source: org_study_id

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