Plasma exchange-centered artificial liver support system in hepatitis B virus-related acute-on-chronic liver failure: a nationwide prospective multicenter study in China.
BACKGROUND
Plasma exchange (PE)-centered artificial liver support system reduced the high mortality rate of hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF). But the data were diverse in different medical centers. The present prospective nationwide study was to evaluate the effects of PE on patients with HBV-ACLF at different stages.


METHODS
From December 2009 to December 2011, we evaluated 250 patients at different stages of HBV-ACLF from 10 major medical centers in China. All the laboratory parameters were collected at admission, before and after PE.


RESULTS
Among the 250 patients who underwent 661 rounds of PE, one-month survival rate was 61.6%; 141 (56.4%) showed improvement after PE. Variables such as age (P=0.000), levels of total bilirubin (TB, P=0.000), direct bilirubin (P=0.000), total triglycerides (P=0.000), low-density lipoprotein (P=0.022), Na+ (P=0.014), Cl- (P=0.038), creatinine (Cr, P=0.007), fibrinogen (P=0.000), prothrombin time (PT, P=0.000), white blood cell (P=0.000), platelet (P=0.003) and MELD (P=0.000) were significantly related to prognosis. Multivariate logistic regression analysis showed that age, disease stage, TB, Cr and PT levels were independent risk factors of mortality among HBV-ACLF patients.


CONCLUSIONS
PE can improve the clinical outcome of patients with HBV-ACLF. Levels of TB, Cr and PT, age and disease stage help to predict prognosis.
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, and Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China. ljli@zju.edu.cn.
Jia-Jia
JJ
Chen
Jian-Rong
JR
Huang
Qian
Q
Yang
Xiao-Wei
XW
Xu
Xiao-Li
XL
Liu
Shao-Rui
SR
Hao
Hui-Fen
HF
Wang
Tao
T
Han
Jing
J
Zhang
Jian-He
JH
Gan
Zhi-Liang
ZL
Gao
Yu-Ming
YM
Wang
Shu-Mei
SM
Lin
Qing
Q
Xie
Chen
C
Pan
Lan-Juan
LJ
Li
D065290:Acute-On-Chronic Liver Failure / Q000097:blood / Q000401:mortality / Q000628:therapy* / Q000821:virology; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D002681:China; D003404:Creatinine / Q000097:blood; D005260:Female; D006509:Hepatitis B / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D006801:Humans; D019164:Liver, Artificial / Q000009:adverse effects; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010951:Plasma Exchange / Q000009:adverse effects / Q000401:mortality; D011446:Prospective Studies; D011517:Prothrombin Time; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D015415:Biomarkers; D003404:Creatinine; D001663:Bilirubin