Frontiers in Medicine (Nov 2021)

Plasma Exchange-Based Non-bioartificial Liver Support System Improves the Short-Term Outcomes of Patients With Hepatitis B Virus-Associated Acute-on-Chronic Liver Failure: A Multicenter Prospective Cohort Study

  • Yuan-yuan Chen,
  • Hai Li,
  • Bao-yan Xu,
  • Xin Zheng,
  • Bei-ling Li,
  • Xian-bo Wang,
  • Yan Huang,
  • Yan-hang Gao,
  • Zhi-ping Qian,
  • Feng Liu,
  • Xiao-bo Lu,
  • Jia Shang,
  • Hai Li,
  • Shao-yang Wang,
  • Yin-hua Zhang,
  • Zhong-ji Meng,
  • Chinese Chronic Liver Failure (CLIF) Consortium,
  • Shan Yin,
  • Wenyi Gu,
  • Yan Zhang,
  • Tongyu Wang,
  • Dandan Wu,
  • Fuchen Dong,
  • Bo Zeng,
  • Liuying Chen,
  • Shijin Wang,
  • Qun Zhang,
  • Yixin Hou,
  • Yuxin Li,
  • Yunyi Huang,
  • Shuning Sun,
  • Wenting Tan,
  • Xiaomei Xiang,
  • Yunjie Dan,
  • Guohong Deng,
  • Jun Chen,
  • Chengjin Liao,
  • Xiaoxiao Liu,
  • Jing Liu,
  • Ling Xu,
  • Shue Xiong,
  • Yan Xiong,
  • Congcong Zou,
  • Jinjun Chen,
  • Congyan Zhu,
  • Chang Jiang,
  • Xiaoyu Wen,
  • Na Gao,
  • Chunyan Liu,
  • Qing Lei,
  • Sen Luo,
  • Haotang Ren,
  • Xue Mei,
  • Jiefei Wang,
  • Liujuan Ji,
  • Tao Li,
  • Xuanqiong Fang,
  • Jing Li,
  • Ziyu Wan,
  • Rongjiong Zheng,
  • Fangrong Jie,
  • Nan Li,
  • Huiming Jin,
  • Hai Li,
  • Qing Zhang,
  • Xuequn Zheng,
  • Shaoyang Wang,
  • Taofa Lin

DOI
https://doi.org/10.3389/fmed.2021.779744
Journal volume & issue
Vol. 8

Abstract

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Background and aims: Hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF) is a complicated syndrome with extremely high short-term mortality. Whether plasma exchange (PE) improves HBV-ACLF outcomes remains controversial. Here, PE-based non-bioartificial liver support system (NB-ALSS) effects on short-term HBV-ACLF patient outcomes were investigated.Materials and methods: HBV-ACLF patients from Chinese Acute-on-chronic Liver Failure (CATCH-LIFE) cohort receiving standard medical therapy (SMT) alone or PE-based NB-ALSS in addition to SMT were allocated to SMT and SMT+PE groups, respectively; propensity score matching (PSM) was used to eliminate confounding bias. Short-term (28/90-day and 1-year) survival rates were calculated (Kaplan-Meier).Results: In total, 524 patients with HBV-ACLF were enrolled in this study; 358 received SMT alone (SMT group), and the remaining 166 received PE-based NB-ALSS in addition to SMT (SMT+PE group). PSM generated 166 pairs of cases. In the SMT+PE group, 28-day, 90-day, and 1-year survival rates were 11.90, 8.00, and 10.90%, respectively, higher than those in the SMT group. Subgroup analysis revealed that PE-based NB-ALSS had the best efficacy in patients with ACLF grade 2 or MELD scores of 30–40 (MELD grade 3). In MELD grade 3 patients who received SMT+PE, 28-day, 90-day, and 1-year survival rates were improved by 18.60, 14.20, and 20.10%, respectively. According to multivariate Cox regression analysis, PE-based NB-ALSS was the only independent protective factor for HBV-ACLF patient prognosis at 28 days, 90 days, and 1 year (28 days, HR = 0.516, p = 0.001; 90 days, HR = 0.663, p = 0.010; 1 year, HR = 0.610, p = 0.051). For those who received SMT+PE therapy, PE-based NB-ALSS therapy frequency was the only independent protective factor for short-term prognosis (28-day, HR = 0.597, p = 0.001; 90-day, HR = 0.772, p = 0.018).Conclusions: This multicenter prospective study showed that the addition of PE-based NB-ALSS to SMT improves short-term (28/90 days and 1-year) outcomes in patients with HBV-ACLF, especially in MELD grade 3 patients. Optimization of PE-based NB-ALSS may improve prognosis or even save lives among HBV-ACLF patients.

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