Impact of Molecular Adsorbent Recirculating System Therapy on Piperacillin Concentration in Critically Ill Patients: An Observational Cohort Study
Authors' conclusion
MARS therapy was associated with a one-third reduction in total plasma piperacillin concentrations per session.
Study context
- Population
- Consecutive adults with acute liver failure or acute-on-chronic liver failure in a university ICU treated with Molecular Adsorbent Recirculating System (MARS) and continuous-infusion piperacillin-tazobactam, March 2023–June 2025121 measurements · 77 sessions
- Participants
- 30 adults
- Exposure
- Piperacillin concentration before vs after MARS sessions
- Outcome
- Relative reduction in plasma piperacillin concentration induced by MARS therapy
Methodological detailssingle-centre, observational
- Single-centre
- Observational
Main finding
As reported in the abstract
Relative reduction in piperacillin concentration per session
Mean relative reduction in piperacillin concentration per session
34%
± 7.9%p < 0.05
Observational data: associations, not effects.
Further findings
Factors associated with piperacillin concentration (univariable mixed-effects)
- MARS session
- β −47.49 mg/L; p < 0.001
- Creatinine clearance
- β −0.37 mg/L per mL/min; p < 0.001
Intra-session piperacillin loss (multivariable)
- Higher creatinine clearance independently associated with greater loss
- P < 0.001
- Higher bilirubin associated with reduced loss
- P = 0.01
Post-session concentrations <80 mg/L
- Post-session concentrations less than 80 mg/L
- 31.6%
- Patients with ≥1 concentration outside predefined target range
- 38%
Original publication
Impact of Molecular Adsorbent Recirculating System Therapy on Piperacillin Concentration in Critically Ill Patients: An Observational Cohort Study. Crit Care Med. Published 16 June 2026. doi:10.
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