Therapeutic Implications of MARS Therapy-Induced Piperacillin Clearance in Critical Liver Failure Patients

Highlight

• MARS therapy leads to a considerable reduction (34%) in plasma piperacillin concentrations per treatment session in critically ill patients with acute or acute-on-chronic liver failure.
• Higher creatinine clearance correlates with increased piperacillin loss during MARS, while elevated bilirubin is associated with reduced drug clearance.
• Approximately one-third of post-MARS piperacillin concentrations fell below the therapeutic target, potentially risking suboptimal antimicrobial exposure.
• Findings advocate for systematic therapeutic drug monitoring (TDM) and tailored antibiotic dosing during MARS therapy to ensure efficacy.

Study Background