**7. Mars and prometheus theory combination**

In a randomized crossover design study, eight patients with ACLF who underwent MARS and Prometheus on alternate days were evaluated, completing 17 sessions for each of the two artificial liver support systems. Cytokine measurements were performed in healthy controls and in patients with ACLF, evidencing elevated IL-6, IL-8, IL-10, TNF-α, and sTNF-αR1 values in the latter group. This work shows that there was no significant decrease in cytokines at the end of treatment and other reviews with both artificial support systems report similar results. The low efficiency is attributed to the high rate of cytokine production due to multiple mechanisms of the perpetuation of the inflammatory response, the greater saturation of the cartridges, or less adsorbent capacity [37–39].
