title: Combined use of non-biological artificial liver treatments for patients with acute liver failure complicated by multiple organ dysfunction syndrome.
abstract: BACKGROUND
  Acute liver failure (ALF) caused by viral and non-viral hepatitis is often accompanied with severe metabolic disorders, the accumulation of toxic substances and continuous release and accumulation of a large number of endogenous toxins and inflammatory mediators. The present study aimed to investigate the effects of various combined non-biological artificial liver treatments for patients with acute liver failure (ALF) complicated by multiple organ dysfunction syndrome (MODS).
  
  
  METHODS
  Thirty-one patients with mid- or late-stage liver failure complicated by MODS (score 4) were randomly divided into three treatment groups: plasmapheresis (PE) combined with hemoperfusion (HP) and continuous venovenous hemodiafiltration (CVVHDF), PE+CVVHDF, and HP+CVVHDF, respectively. Heart rate (HR) before and after treatment, mean arterial pressure (MAP), respiratory index (PaO2/FiO2), hepatic function, platelet count, and blood coagulation were determined.
  
  
  RESULTS
  Significant improvement was observed in HR, MAP, PaO2/FiO2, total bilirubin (TBIL) and alanine aminotransferase (ALT) levels after treatment (P<0.05). TBIL and ALT decreased more significantly after treatment in the PE+CVVHDF and PE+HP+CVVHDF groups (P<0.01). Prothrombin time (PT) and albumin were significantly improved only in the PE+CVVHDF and PE+HP+CVVHDF groups (P<0.05). TBIL decreased more significantly in the PE+HP+CVVHDF group than in the HP+CVVHDF and PE+CVVHDF groups (P<0.05). The survival rate of the patients was 58.1% (18/31), viral survival rate 36.4% (4/11), and non-viral survival rate 70% (14/20).
  
  
  CONCLUSIONS
  Liver function was relatively improved after treatment, but PE+HP+CVVHDF was more efficient for the removal of toxic metabolites, especially bilirubin. The survival rate was significantly higher in the patients with non-viral liver failure than in those with viral liver failure.
authors.affiliation: Department of Intensive Care, Xuzhou Central Hospital, Affiliated to School of Medicine, Southeast University, Xuzhou 221009, China.
authors.forename: Mao-Qin
authors.initials: MQ
authors.lastname: Li
authors.affiliation: Department of Intensive Care, Xuzhou Central Hospital, Affiliated to School of Medicine, Southeast University, Xuzhou 221009, China.
authors.forename: Jun-Xiang
authors.initials: JX
authors.lastname: Ti
authors.affiliation: Department of Intensive Care, Xuzhou Central Hospital, Affiliated to School of Medicine, Southeast University, Xuzhou 221009, China.
authors.forename: Yun-Hang
authors.initials: YH
authors.lastname: Zhu
authors.affiliation: Department of Intensive Care, Xuzhou Central Hospital, Affiliated to School of Medicine, Southeast University, Xuzhou 221009, China.
authors.forename: Zai-Xiang
authors.initials: ZX
authors.lastname: Shi
authors.affiliation: Department of Intensive Care, Xuzhou Central Hospital, Affiliated to School of Medicine, Southeast University, Xuzhou 221009, China.
authors.forename: Ji-Yuan
authors.initials: JY
authors.lastname: Xu
authors.affiliation: Department of Intensive Care, Xuzhou Central Hospital, Affiliated to School of Medicine, Southeast University, Xuzhou 221009, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Lu
authors.affiliation: Department of Intensive Care, Xuzhou Central Hospital, Affiliated to School of Medicine, Southeast University, Xuzhou 221009, China.
authors.forename: Jia-Qiong
authors.initials: JQ
authors.lastname: Li
authors.affiliation: Department of Intensive Care, Xuzhou Central Hospital, Affiliated to School of Medicine, Southeast University, Xuzhou 221009, China.
authors.forename: Xiao-Meng
authors.initials: XM
authors.lastname: Wang
authors.affiliation: Department of Intensive Care, Xuzhou Central Hospital, Affiliated to School of Medicine, Southeast University, Xuzhou 221009, China.
authors.forename: Yan-Jun
authors.initials: YJ
authors.lastname: Xu
keywords: Artificial liver; Continuous veno-venous hemodiafiltration; Hemoperfusion; Plasma exchange; Severe acute liver failure