Effects on Plasma Exchange on Functional Capacity of Serum Albumin, Circulatory Dysfunction, Renal and Cerebral Function in Cirrhotic Patients With "Acute-on-chronic Liver Failure"

Exclusion Criteria

• •Neoplasm disease including hepatocarcinoma which exceed Milan criteria (1 tumour \> 5cm, up to 3 tumours \<3 cm)
• •Active bacterial or fungal infection with hemodynamic instability which require the utilization of vasoactive drugs at moderate dose (\>0,5 μg/Kg/min of noradrenaline)
• •Structural moderate to severe cardiopathy (Cardiac Index \<2l/min/m2)
• •Chronic renal insufficiency in treatment with haemodialysis
• •Chronic moderate o severe pulmonary disease (maximum expiratory volume in a second \<50%)
• •Active transplant
• •human immunodeficiency virus infection
• •Pregnancy or lactation
• •Acute respiratory distress syndrome (P02/Fi02\< 200mm Hg) or acute lung injury (P02/Fi02\< 300mm Hg)
• •Hemodynamic instability (\>0,5 μg/Kg/min of noradrenaline)
• •Bleeding in the digestive tract in the previous 72h to the treatment
• •Severe coagulopathy: INR ≥ 3.0 (Quick ≤ 20%) and/or platelets \< 30000//mm3
• •Extrahepatic cholestasis
• •Hepatobiliary surgery in the last 6 months (except laparoscopic Cholecystectomy)
• •Concentrations bilirubin ≥ 5mg/dl during the period above 4 weeks previous to inclusion
• •Concomitant participation in an other clinical trial
• •Drug addiction
• •Mental status which does not allow the patient to understand the trial, with the exception of hepatic encephalopathy.