title: Therapeutic plasma exchange versus double plasma molecular absorption system in hepatitis B virus-infected acute-on-chronic liver failure treated by entercavir: A prospective study.
abstract: BACKGROUND
  Therapeutic plasma exchange (TPE) and double plasma molecular absorption system (DPMAS) were two extracorporeal liver support systems. Few studies compared their efficacy profile.
  
  
  OBJECTIVE
  This study was to compare the efficacy of TPE and DPMAS on acute-on-chronic liver failure (ACLF) caused by hepatitis B virus (HBV-ACLF).
  
  
  METHODS
  60 HBV-ACLF patients were enrolled and prospectively studied. All patients received entecavir therapy, and were assigned to TPE group (n = 33) and DPMAS group (n = 27). Primary end-points were the effects of TPE and DPMAS on liver function and serum inflammatory markers.
  
  
  RESULTS
  Serum procalcitonin, interleukin (IL)-6, and high sensitive C-reactive protein (hsCRP) were significantly elevated in patients with HBV-ACLF. TPE achieved significantly higher removal rates of total bilirubin (TBIL, P = .002), direct bilirubin (DBIL, P = .006), and hsCRP (P = .010) than DPMAS, but DPMAS displayed lower loss rate of albumin (P = .000). TPE and DPMAS resulted in similarly increased serum IL-6 levels and comparable 12-week survivals (P > .05). Multivariate analysis showed that hospital stay (Relative Risk [RR]: 1.062, 95% Confidence Interval [CI]: 1.011-1.115, P = .016), prothrombin time (RR: 1.346, 95% CI: 1.077-1.726, P = .010), and international normalized ratio (RR: 0.013, 95% CI: 0.006-0.788, P = .041) were independent predictors for 12-week survival. Both TPE and DPMAS treatments were well-tolerated.
  
  
  CONCLUSIONS
  Compared to DPMAS, TPE was more efficient in eliminating TBIL, DBIL, and hsCRP, but it was associated with higher loss rate of albumin. TPE and DPMAS were similar in improving 12-week survivals in HBV-ACLF.
authors.affiliation: Gastroenterology Department II or Hepatology Center, The Second Affiliated Hospital of Kunming Medical University, Kunming City, 650101, Yunnan Province, China.|Graduate Department of Kunming Medical University, Kunming City, 650500, Yunnan Province, China.
authors.forename: Yue-Meng
authors.identifier: http://orcid.org/0000-0002-6381-922X
authors.initials: YM
authors.lastname: Wan
authors.affiliation: Gastroenterology Department II or Hepatology Center, The Second Affiliated Hospital of Kunming Medical University, Kunming City, 650101, Yunnan Province, China.
authors.forename: Yu-Hua
authors.initials: YH
authors.lastname: Li
authors.affiliation: Gastroenterology Department II or Hepatology Center, The Second Affiliated Hospital of Kunming Medical University, Kunming City, 650101, Yunnan Province, China.
authors.forename: Zhi-Yuan
authors.initials: ZY
authors.lastname: Xu
authors.affiliation: Gastroenterology Department II or Hepatology Center, The Second Affiliated Hospital of Kunming Medical University, Kunming City, 650101, Yunnan Province, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Yang
authors.affiliation: Gastroenterology Department II or Hepatology Center, The Second Affiliated Hospital of Kunming Medical University, Kunming City, 650101, Yunnan Province, China.
authors.forename: Li-Hong
authors.initials: LH
authors.lastname: Yang
authors.affiliation: Gastroenterology Department II or Hepatology Center, The Second Affiliated Hospital of Kunming Medical University, Kunming City, 650101, Yunnan Province, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Xu
authors.affiliation: Gastroenterology Department II or Hepatology Center, The Second Affiliated Hospital of Kunming Medical University, Kunming City, 650101, Yunnan Province, China.
authors.forename: Jin-Hui
authors.initials: JH
authors.lastname: Yang
mesh_terms: D065966:Absorption, Physicochemical; D065290:Acute-On-Chronic Liver Failure / Q000188:drug therapy* / Q000628:therapy / Q000821:virology; D000328:Adult; D000998:Antiviral Agents; D001663:Bilirubin / Q000302:isolation & purification; D002097:C-Reactive Protein / Q000302:isolation & purification; D005260:Female; D006147:Guanine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006515:Hepatitis B virus; D006801:Humans; D008297:Male; D008875:Middle Aged; D010951:Plasma Exchange; D011446:Prospective Studies; D016019:Survival Analysis
chemical_list: D000998:Antiviral Agents; C413685:entecavir; D006147:Guanine; D002097:C-Reactive Protein; D001663:Bilirubin
keywords: C-reactive protein; acute-on-chronic liver failure; artificial liver support system; double plasma molecular absorption system; interleukin-6; procalcitonin; therapeutic plasma exchange