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Ma Y, Xu Y, Du L, Bai L, Tang H. Outcome of patients with different stages of acute-on-chronic liver failure treated with artificial liver support system. Front Med (Lausanne) 2024; 11:1381386. [PMID: 38835796 PMCID: PMC11149554 DOI: 10.3389/fmed.2024.1381386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 04/26/2024] [Indexed: 06/06/2024] Open
Abstract
Background Elevated international normalized ratio of prothrombin time (PT-INR) is one of the key characteristics of acute-on-chronic liver failure (ACLF). Whether the staging of PT-INR has the ability to screen out subgroups of ACLF patients who would be more eligible for artificial liver support system (ALSS) treatment has not been studied in detail. Methods A previous study enrolled patients receiving ALSS treatment with regional citrate anticoagulation from January 2018 to December 2019. Patients with different PT-INR intervals were retrospectively enrolled: 1.3 ≤ PT-INR < 1.5 (Pre-stage), 1.5 ≤ PT-INR < 2.0 (Early-stage), 2.0 ≤ PT-INR < 2.5 (Mid-stage), and PT-INR ≥ 2.5 (End-stage). The Cox proportional hazards models were used to estimate the association between stages of ACLF or sessions of ALSS treatment and 90 day mortality. Results A total of 301 ACLF patients were enrolled. The 90 day mortality risk of Early-stage ACLF patients (adjusted hazard ratio (aHR) (95% confidence interval (CI)), 3.20 (1.15-8.89), p = 0.026), Mid-stage ACLF patients (3.68 (1.34-10.12), p = 0.011), and End-stage ACLF patients (12.74 (4.52-35.91), p < 0.001) were higher than that of Pre-stage ACLF patients, respectively. The 90 day mortality risk of Mid-stage ACLF patients was similar to that of Early-stage ACLF patients (1.15 (0.69-1.94), p = 0.591). The sessions of ALSS treatment was an independent protective factor (aHR (95% CI), 0.81 (0.73-0.90), p < 0.001). The 90 day mortality risk in ACLF patients received 3-5 sessions of ALSS treatment was lower than that of patients received 1-2 sessions (aHR (95% CI), 0.34 (0.20-0.60), p < 0.001), whereas the risk in patients received ≥6 sessions of ALSS treatment was similar to that of patients received 3-5 sessions (0.69 (0.43-1.11), p = 0.128). Conclusion ACLF patients in Pre-, Early-, and Mid-stages might be more eligible for ALSS treatment. Application of 3-5 sessions of ALSS treatment might be reasonable.
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Affiliation(s)
- Yuanji Ma
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China
| | - Yan Xu
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China
| | - Lingyao Du
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China
| | - Lang Bai
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China
| | - Hong Tang
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China
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Wu C, Peng W, Cheng D, Gu H, Liu F, Peng S, Fu L. Efficacy and Economic Evaluation of Nonbiological Artificial Liver Therapy in Acute-on-chronic Hepatitis B Liver Failure. J Clin Transl Hepatol 2023; 11:433-440. [PMID: 36643036 PMCID: PMC9817044 DOI: 10.14218/jcth.2022.00106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/27/2022] [Accepted: 06/12/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND AND AIMS Nonbiological artificial liver (NBAL) is frequently used as a first-line treatment for hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF). This study aimed to compare the therapeutic efficacy and cost-effectiveness ratio (CER) of comprehensive medical treatment, plasma exchange (PE), and double plasma molecular adsorption system (DPMAS) plus half-dose PE (DPMAS+PE) in patients with HBV-ACLF. METHODS A total of 186 patients with HBV-ACLF randomly received comprehensive medical treatment, PE, or DPMAS+PE and were prospectively evaluated. Patients were divided into four subgroups based on the pretreatment prothrombin activity (PTA): Group I (PTA>40%), group II (PTA 30-40%), group III (PTA 20-30%), and group IV (PTA<20%). The main outcome measures were 28 day effectiveness; 90 day liver transplantation-free survival; change of biochemical parameters; and CER. RESULTS DPMAS+PE treatment was associated with significantly higher 28 day effectiveness and 90 day liver transplantation-free survival compared with PE treatment in patients with group I liver failure. Clearance of serum total bilirubin (TBIL), AST, and creatinine (Cr) were significantly higher in the DPMAS+PE group than in the PE group. For subjects with group I liver failure, DPMAS+PE treatment had advantages of lower CER values and better cost-effectiveness. CONCLUSIONS Compared with comprehensive medical treatment and PE alone, DPMAS with half-dose sequential PE treatment more effectively improved TBIL, AST, and Cr in HBV-ACLF patients, improved 28 day effectiveness and 90 day survival rates in patients with group I liver failure, and was more cost effective. DPMAS+PE is a viable NBAL approach for treatment of HBV-ACLF.
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Affiliation(s)
- Cichun Wu
- Department of Infectious Diseases, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Wenting Peng
- Department of Infectious Diseases, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Da Cheng
- Department of Infectious Diseases, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Huimin Gu
- Department of Infectious Diseases, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Fei Liu
- Department of Infectious Diseases, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Shifang Peng
- Department of Infectious Diseases, Xiangya Hospital Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Lei Fu
- Department of Infectious Diseases, Xiangya Hospital Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital Central South University, Changsha, Hunan, China
- Correspondence to: Lei Fu, Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China. ORCID: https://orcid.org/0000-0001-7550-1254. Tel: +86-731-89753067, Fax: +86-731-4327332, E-mail:
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Gao Q, Xin XW, Zhao C, Wang YJ, Wang W, Yin Y, Wang XR, Jin YP. Efficacy of HA330-II column hemoadsorption in Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis combined with liver failure: A case report. World J Hematol 2022; 9:6-12. [DOI: 10.5315/wjh.v9.i1.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 12/09/2021] [Accepted: 02/13/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hemophagocytic lymphohistiocytosis (HLH) is a severe and potentially deadly condition associated with extensive inflammation and immune activation. Cytokine adsorption may serve as a supportive treatment that can stabilize organ function in affected patients by reducing their circulating cytokines levels. To date, no descriptions of clinical experiences associated with the use of HA330-II column hemoadsorption for the treatment of children affected by HLH have been published.
CASE SUMMARY We describe the case of an 11-year-old child with Epstein-Barr virus-associated HLH complicated by liver failure. She underwent HA330-II column hemoadsorption and chemotherapy and exhibited reductions in levels of inflammatory cytokines, including interleukin (IL), IL-6, IL-8, IL-10, and interferon-γ. The patient’s condition and laboratory parameters gradually improved with treatment.
CONCLUSION Hemoadsorption may play an important role in cytokine storm elimination in children with HLH combined with liver failure and consequent multiple organ failure.
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Affiliation(s)
- Qian Gao
- Pediatric Intensive Care Unit, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250021, Shandong Province, China
| | - Xiao-Wei Xin
- Pediatric Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
| | - Chun Zhao
- Pediatric Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
| | - Yu-Juan Wang
- Pediatric Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
| | - Wei Wang
- Pediatric Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
| | - Yi Yin
- Pediatric Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
| | - Xiao-Ru Wang
- Pediatric Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
| | - You-Peng Jin
- Pediatric Intensive Care Unit, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250021, Shandong Province, China
- Pediatric Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
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Xu W, Li Y, Wang L, Gao H, Chen J, Yuan J, Ouyang Y, Gao Y, Li J, Li X, Peng L. Efficacy and safety of combination treatment of double plasma molecular adsorption system and low volume plasma exchange for patients with hepatitis B virus related acute-on-chronic liver failure: a multicentre randomised controlled clinical trial. BMJ Open 2021; 11:e047690. [PMID: 34907041 PMCID: PMC8671914 DOI: 10.1136/bmjopen-2020-047690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 11/22/2021] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Hepatitis B virus (HBV) related acute-on-chronic liver failure (ACLF) is still a common type of liver failure in China. Therefore, we conduct this multicentre, non-blinded, randomised controlled clinical trial to investigate the efficacy and safety of combination treatment of double plasma molecular adsorption system (DPMAS) and low volume plasma exchange (PE) for patients with HBV related ACLF. METHODS AND ANALYSIS A total of 200 patients with HBV related ACLF in the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou Eighth People's Hospital, Nanfang Hospital of Southern Medical University, The Third People's Hospital of Shenzhen, Xiangya Hospital of Central South University and The First Affiliated Hospital of Anhui Medical University, will be recruited into this trial. Eligible patients will undergo randomisation at a 1:1 ratio to two arms: the control group and the trial group. Patients in control group will receive comprehensive internal medical treatment. Patients in trial group will receive treatment of DPMAS and sequential low volume PE for three times, and comprehensive internal medical treatment. Clinical safety will be assessed by the analysis of adverse events (AEs) and laboratory tests. The primary efficacy outcome will be the incidence of unfavored events including death, liver transplantation and treatment abandonment. The secondary efficacy outcome will be the model for end-stage liver disease score variation. All evaluations will be performed at baseline, and 4, 8, 12, 24, 36, 48 weeks after enrolment. All AEs will be reported as soon as they are noted during the entire study procedure. ETHICS AND DISSEMINATION This study was approved by Ethics Committee of the Third Affiliated Hospital of Sun Yat-sen University (approval no. (2020)02-173-01). The results and conclusions of this clinical trial will be published at academic conferences or in journals. TRIAL REGISTRATION NUMBER NCT04597164.
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Affiliation(s)
- Wenxiong Xu
- Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yangmei Li
- Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Lu Wang
- Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Hongbo Gao
- Guangzhou Eighth People's Hospital, Guangzhou, China
| | - Jinjun Chen
- Southern Medical University Nanfang Hospital, Guangzhou, China
| | - Jing Yuan
- The Third People's Hospital of Shenzhen, Shenzhen, China
| | - Yi Ouyang
- Xiangya Hospital Central South University, Changsha, China
| | - Yufeng Gao
- First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jianguo Li
- Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xuejun Li
- Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Liang Peng
- Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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Guo X, Wu F, Guo W, Zhang J, Yang Y, Lu Y, Yin C, Fan H, Xu J, Liao M. Comparison of plasma exchange, double plasma molecular adsorption system, and their combination in treating acute-on-chronic liver failure. J Int Med Res 2021; 48:300060520932053. [PMID: 32552092 PMCID: PMC7303772 DOI: 10.1177/0300060520932053] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Objective Our objective was to compare the effectiveness of nonbiological artificial
liver (NBAL) support, particularly short-term (28-day) survival rates, in
patients who underwent treatment using double plasma molecular adsorption
system (DPMAS), plasma exchange (PE), or combined PE+DPMAS, in addition to
comprehensive physical treatment for different stages of acute-on-chronic
liver failure (ACLF). Methods We retrospectively reviewed clinical data of 135 patients with ACLF who
received NBAL treatment between November 2015 and February 2019. The
patients were categorized into PE, DPMAS, and PE+DPMAS groups. Short-term
effectiveness of treatment was assessed and compared based on selected
clinical findings, laboratory parameters, and liver function markers. Results Coagulation function improved significantly in all groups after treatment. In
the PE and PE+DPMAS groups, prothrombin time decreased to different degrees,
whereas plasma thromboplastin antecedent increased significantly after
treatment. White blood cell counts increased and platelet counts decreased
in all groups after treatment. The model for end-stage liver disease score,
Child–Pugh grade, systematic inflammatory syndrome score, and sepsis-related
organ failure score decreased in all three groups after treatment. Conclusions PE, DPMAS, and PE+DPMAS improved disease indicators in all patients with
ACLF. The combined treatment improved the short-term effectiveness of
treatment, especially in patients with mild ACLF.
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Affiliation(s)
- Xiju Guo
- Gastroenterology Department of People's Hospital of Baoshan City, Baoshan City, Baoshan, China
| | - Fengqing Wu
- Gastroenterology Department of People's Hospital of Baoshan City, Baoshan City, Baoshan, China
| | - Weibo Guo
- Gastroenterology Department of Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jiachang Zhang
- Gastroenterology Department of People's Hospital of Baoshan City, Baoshan City, Baoshan, China
| | - Yan Yang
- Gastroenterology Department of People's Hospital of Baoshan City, Baoshan City, Baoshan, China
| | - Yajing Lu
- Gastroenterology Department of People's Hospital of Baoshan City, Baoshan City, Baoshan, China
| | - Congbo Yin
- Gastroenterology Department of People's Hospital of Baoshan City, Baoshan City, Baoshan, China
| | - Hongxing Fan
- Gastroenterology Department of People's Hospital of Baoshan City, Baoshan City, Baoshan, China
| | - Juan Xu
- Gastroenterology Department of People's Hospital of Baoshan City, Baoshan City, Baoshan, China
| | - Mingmei Liao
- Gastroenterology Department of People's Hospital of Baoshan City, Baoshan City, Baoshan, China
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