Hepa Wash Treatment of Patients With Acute-on-Chronic Liver Failure in Intensive Care Units

Inclusion Criteria: 1. Patients with documented clinical or histological evidence of cirrhosis AND 2. Acute decompensation in previously stable cirrhotic liver disease AND 3. Bilirubin ≥ 2 mg/dl AND 4. SOFA ≥ 9 calculated after 12 hours of optimal medical therapy AND 5. Patient is in the intensive care unit AND 6. Informed consent of the patient or the legal representative AND 7. Patients are 18y or older AND 8. Enrollment of patients within 96 hours of fulfilling inclusion criteria (1-5) Exclusion Criteria: 1. Untreatable extrahepatic cholestasis 2. Patient has a survival prognosis of less than 6 weeks because of a chronic disease (e.g. metastasizing cancer) and before the acute event which lead to the ICU admission. 3. PaO2/FIO2 ≤ 100 mmHg (respiratory SOFA-score of 4) 4. Patients who receive a vasopressor support of Dopamine \>15 µg/kg/min or epinephrine \>0.1 µg/kg/min or norepinephrine \>0.1 µg/kg/min (cardiovascular SOFA-score of 4) 5. Patients with creatinine ≥5 mg/dl or urine output \<200 ml/day (renal SOFA-score of 4) 6. Patients on kidney dialysis 7. Patient with MELD-score of 40 8. Mean arterial pressure ≤ 50 mmHg despite conventional medical treatment 9. Patient testament excludes the use of life-prolonging measures 10. Post-operative patients whose liver failure is related to liver surgery 11. Uncontrolled seizures 12. Active or uncontrolled bleeding 13. Weight ≥ 120 kg 14. Pregnancy 15. Patient diagnosed with Creutzfeldt-Jakob disease 16. Participation in another clinical study