The curative effect of ALSS on 1-month mortality in AoCLF patients after 72 to 120 hours.
BACKGROUND
Hepatitis B virus (HBV)-related acute-on-chronic liver failure (AoCLF) is associated with a high mortality rate. An artificial liver support system (ALSS) creates a better environment for the self-regeneration of retained hepatocytes. AIM AND PATIENTS: We investigated the curative effect of ALSS on 1-month mortality at 72-120 h post-ALSS in 289 AoCLF patients.


METHODS
Of the 289 patients, 117 who survived for at least 1 month post-ALSS comprised the survival group; the remaining cases who died within 1 month served as controls. The improvements in laboratory data and clinical syndromes at 72-120 h post-ALSS were compared with those at 24 h.


RESULTS
Total bilirubin, international normalized ratio, and creatinine levels, and encephalopathy were significantly improved at 24 h post-ALSS in both the groups (p<0.05); however, these variables showed deterioration at 72-120 h; a rebound occurred in the nonsurvivors (p>0.05). The improvements in these variables in the nonsurvivors were considerably smaller than those in the survivors (p<0.05), particularly at 72-120 h. One-month mortality was more accurately predicted by the logistic regression model at 72-120 h than at 24 h.


CONCLUSIONS
The prognosis of AoCLF patients was highly dependent on the improvement in encephalopathy, total bilirubin, international normalized ratio, and creatinine levels at 72-120 h post-ALSS. These variables are useful, therefore, as disease severity indexes to determine organ allocation priorities for liver transplant.
Chen
Y-S
YS
State Key Laboratory of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
Wu
Z-W
ZW
He
J-Q
JQ
Yu
J
J
Yang
S-G
SG
Zhang
Y-M
YM
Du
W-B
WB
Cao
H-C
HC
Li
L-J
LJ
D000328:Adult; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers; D016022:Case-Control Studies; D002681:China / Q000453:epidemiology; D003404:Creatinine / Q000097:blood; D005260:Female; D006501:Hepatic Encephalopathy / Q000628:therapy; D019694:Hepatitis B, Chronic / Q000150:complications*; D006801:Humans; D019934:International Normalized Ratio; D017114:Liver Failure, Acute / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D019164:Liver, Artificial; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
D015415:Biomarkers; D003404:Creatinine; D001663:Bilirubin