Abstract
Background and aims
Artificial liver support systems (ALSS) have been shown to significantly reduce mortality in patients with acute-on-chronic liver failure (ACLF). However, the characteristics of patients who would benefit most from ALSS treatment are poorly understood. This study aimed to delineate the indicators for ALSS and evaluate the effectiveness of plasma perfusion combined with plasma exchange (PP + PE) in patients with hepatitis B virus-related ACLF (HBV-ACLF).
Methods
A total of 898 patients with HBV-ACLF in a single center were enrolled retrospectively. Propensity score matching (PSM) was used in case-paired analysis. Hepatic or extra-hepatic organ failures were defined by Chronic Liver Failure-Sequential Organ Failure Assessment (CLIF-SOFA) criteria. Complications included ascites, infection, hepatopulmonary syndrome, hepatorenal syndrome, hepatic encephalopathy and upper gastrointestinal bleeding. Numbers of organ failures or complications were used for risk stratification.
Results
Among all patients, 418 patients received standard medical therapy (SMT) and 480 received PP + PE plus SMT. After one-to-one paired PSM within the two groups without risk stratification, 293 pairs were enrolled. The PP + PE group displayed significantly lower mortality risk in both 28- and 90-day observation durations. When stratified, patients with two or more organ failures or complications from the PP + PE group showed greater decrease in mortality risk. Moreover, PP + PE treatment significantly increased the resolution of organ failures and complications and ameliorated the development of new organ failures and complications.
Conclusions
PP + PE treatment significantly reversed organ failures and ameliorated the development of new organ failures and complications, thus reducing mortality risk of patients with HBV-ACLF.
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Abbreviations
- AARC:
-
Asian Pacific Association for the Study of Liver (APASL) ACLF Research Consortium
- ACLF:
-
Acute-on-chronic liver failure
- HBV:
-
Hepatitis B virus
- TPPMs:
-
Tongji prognostic predictor model score
- COSSH-ACLFs:
-
Chinese Group on the Study of Severe Hepatitis B-ACLF score
- CLIF-C:
-
Chronic Liver Failure Consortium
- OFs:
-
Organ failure score
- MELDs:
-
Model for End-stage Liver Disease score
- Nas:
-
Sodium score
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Funding
This study was funded by the National Thirteenth “Five Years” Project in Science and Technology of China (2017ZX10202201, 2018ZX10302-206).
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All authors were involved in critical revision of manuscript. TC and QN contributed to the study conception and design. ZY, ZZ, QC, GC, WL, KM and WG enrolled patients and collected clinical data. ZY analyzed clinical data and drafted the manuscript. XL had contributions to the revision of manuscript in discussion, data re-evaluation and presentation, and manuscript edition. All authors approved the final version of the manuscript, including the authorship list.
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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (the Human Ethics Committee of Tongji Medical College, Huazhong University of Science and Technology, China) and with the Helsinki Declaration of 1975, as revised in 2008(5).
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Informed consent was obtained from all individual participants included in this study.
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Yang, Z., Zhang, Z., Cheng, Q. et al. Plasma perfusion combined with plasma exchange in chronic hepatitis B-related acute-on-chronic liver failure patients. Hepatol Int 14, 491–502 (2020). https://doi.org/10.1007/s12072-020-10053-x
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DOI: https://doi.org/10.1007/s12072-020-10053-x