AIM:To evaluate whether treatment with thePrometheus~(R)system significantly affects cytokines,coagulation factors and other plasma proteins.METHODS:We studied nine patients with acute-on-chronic liver failure and accompanying renal failure.Prometheus~(R)therapy was performed on 2 consecutivedays for up to 6 h in all patients.Several biochemicalparameters and blood counts were assessed at regulartime points during Prometheus~(R)treatment.RESULTS:We observed a significant decrease of bothprotein-bound(e.g.bile acids)and water-soluble(e.g.ammonia)substances after Prometheus~(R)therapy.Eventhough leukocytes increased during treatment(P<0.01),we found no significant changes of C-reactive protein,interleukin-6,and tumor necrosis factor-a plasma levels(all P>0.5).Further,antithrombin 3,factor Ⅱ and factorV plasma levels did not decrease during Prometheus~(R)therapy(all P>0.5),and the INR remained unchanged(P=0.4).Plasma levels of total protein,albumin,andfibrinogen were also not altered during Prometheus~(R)treatment(all P>0.5).Finally,platelet count did notchange significantly during therapy(P=0.6).CONCLUSION:Despite significant removal of protein-bound and water-soluble substances,Prometheus~(R)therapy did not affect the level of cytokines,coagulationfactors or other plasma proteins.Thus,the filters andadsorbers used in the system are highly effective andspecific for water-soluble substances and toxins bound tothe albumin fraction. AIM: To evaluate whether treatment with the Prometheus ~ (R) system significantly affects cytokines, coagulation factors and other plasma proteins. METHODS: We studied nine patients with acute-on-chronic liver failure and accompanying renal failure. Prometheus ~ (R) therapy was Perform on 2 consecutive days for up to 6 h in all patients. Sever biochemical parameters and blood counts were assessed at regulartime points during Prometheus ~ (R) treatment .RESULTS: We observed a significant decrease of both protein-bound (egbile acids) and water- soluble (egammonia) substances after Prometheus ~ (R) therapy. Eleventh week leukocytes increased during treatment (P <0.01), we found no significant changes of C-reactive protein, interleukin-6, and tumor necrosis factor- P> 0.5) .Further, antithrombin 3, factor II and factorV plasma levels did not reduce during Prometheus ~ (R) therapy (all P> 0.5), and the INR remained unchanged (P = 0.4) .Plasma levels of total protein, albumin, andfibrinogen were also not for altered du ring Prometheus R treatment (all P> 0.5) .Finally, platelet count did not change significantly during therapy (P = 0.6) .CONCLUSION: Despite significant removal of protein-bound and water-soluble substances, Prometheus ~ (R) therapy did not affect the level of cytokines, coagulation factors or other plasma proteins. Thus, the filters and adhesives used in the system are highly effective and specific for water-soluble substances and toxins bound tothe albumin fraction.