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Current Molecular Medicine

Editor-in-Chief

ISSN (Print): 1566-5240
ISSN (Online): 1875-5666

Research Article

Observation on the Effect of Sequentially Combined Multi-modal Artificial Liver Treatment on HBV-related Acute-on-chronic Liver Failure

Author(s): Xueshi Zhou, Youhan Miu, Xiaoye Guo, Jun Wang, Tingting Su, Hejuan Du, Sen Wang, Ying Zhang, Yuanwang Qiu and Weifeng Zhao*

Volume 24, Issue 9, 2024

Published on: 03 October, 2023

Page: [1152 - 1158] Pages: 7

DOI: 10.2174/0115665240253035230920041207

Price: $65

Abstract

Objective: To observe the short-term effect of sequentially combined multimodal artificial liver treatment (SCMALT) on HBV-related acute-on-chronic liver failure (HBV-ACLF).

Methods: HBV-ACLF patients 155 cases undergoing artificial liver treatment were analyzed, and they were sorted into the SCMALT group and the conventional-modal artificial liver treatment (CALT) group. The clinical data of all patients were recorded and the serum levels of interleukin-8 (IL-8), chemokine interferon-inducible protein-10 (IP-10), and interleukin-6 (IL-6) were detected. The changes in the 30-day survival rate, cytokine level, model for end-stage liver disease (MELD) score, and complications of artificial liver treatment were analyzed.

Results: After being followed up for 30 days, 104 patients survived and 51 died. At the end of the whole-course treatment, the decreases in IL-6, IP-10, and IL-8 levels and MELD scores in the SCMALT group were greater than in the CALT group. Cox regression suggested WBC (OR=1.066, 95% CI 1.012-1.123, P=0.017), AT-III activity (OR=0.935, 95% CI 0.907-0.964, p=0.000) at baseline, artificial liver treatment mode (OR=0.362, 95% CI 0.164-0.800, p=0.012), number of artificial liver treatments (OR=0.65695% CI 0.436-0.986, p=0.043), spontaneous peritonitis (OR=0.337, 95% CI 0.165-0.689, p=0.003), and hepatic encephalopathy (OR=0.104, 95% CI 0.028-0.388, p=0.001) were independent influencing factors of 30-day survival rate. SCMALT can significantly prolong the survival period of the patient. No obvious difference was shown in the proportions of bleeding and circulation instability between the two groups (p>0.05).

Conclusion: Compared with the CALT, SCMALT can more effectively remove inflammatory mediators and reduce the MELD score in HBV-ACLF patients, which can obviously ameliorate the prognosis, with less effect on the platelet count.

[1]
Wu T, Li J, Shao L, et al. Development of diagnostic criteria and a prognostic score for hepatitis B virus-related acute-on-chronic liver failure. Gut 2018; 67(12): 2181-91.
[http://dx.doi.org/10.1136/gutjnl-2017-314641] [PMID: 28928275]
[2]
Bernardi M, Moreau R, Angeli P, Schnabl B, Arroyo V. Mechanisms of decompensation and organ failure in cirrhosis: From peripheral arterial vasodilation to systemic inflammation hypothesis. J Hepatol 2015; 63(5): 1272-84.
[http://dx.doi.org/10.1016/j.jhep.2015.07.004] [PMID: 26192220]
[3]
Li LJ, Zhang YM, Liu XL, et al. Artificial liver support system in China: A review over the last 30 years. Ther Apher Dial 2006; 10(2): 160-7.
[http://dx.doi.org/10.1111/j.1744-9987.2006.00358.x] [PMID: 16684218]
[4]
Xu X, Liu X, Ling Q, et al. Artificial liver support system combined with liver transplantation in the treatment of patients with acute-on-chronic liver failure. PLoS One 2013; 8(3): e58738.
[http://dx.doi.org/10.1371/journal.pone.0058738] [PMID: 23516546]
[5]
Zhou L, Chen Y. Model selection and curative effect judgment criteria for artificial liver in the treatment of liver failure. Zhonghua Gan Zang Bing Za Zhi 2022; 30(2): 127-30.
[PMID: 35359063]
[6]
Bachli EB, Schuepbach RA, Maggiorini M, Stocker R, Müllhaupt B, Renner EL. Artificial liver support with the molecular adsorbent recirculating system: Activation of coagulation and bleeding complications. Liver Int 2007; 27(4): 475-84.
[http://dx.doi.org/10.1111/j.1478-3231.2006.01398.x] [PMID: 17403187]
[7]
Han L, Han T, Nie C, Zhang Q, Cai J. Elevated mean platelet volume is associated with poor short-term outcomes in hepatitis B virus-related acute-on-chronic liver failure patients. Clin Res Hepatol Gastroenterol 2015; 39(3): 331-9.
[http://dx.doi.org/10.1016/j.clinre.2014.10.006] [PMID: 25465870]
[8]
Sarin SK, Choudhury A, Sharma MK, et al. Acute-on-chronic liver failure: Consensus recommendations of the Asian Pacific association for the study of the liver (APASL): An update. Hepatol Int 2019; 13(4): 353-90.
[http://dx.doi.org/10.1007/s12072-019-09946-3] [PMID: 31172417]
[9]
Qin G, Shao JG, Wang B, et al. Artificial liver support system improves short- and long-term outcomes of patients with HBV-associated acute-on-chronic liver failure: A single-center experience. Medicine 2014; 93(28): e338.
[http://dx.doi.org/10.1097/MD.0000000000000338] [PMID: 25526495]
[10]
Xiao LL, Xu XW, Huang KZ, Zhao YL, Zhang LJ, Li LJ. Artificial liver support system improves short-term outcomes of patients with hbv-associated acute-on-chronic liver failure: A propensity score analysis. BioMed Res Int 2019; 2019: 1-8.
[http://dx.doi.org/10.1155/2019/3757149] [PMID: 31871940]
[11]
Larsen FS, Schmidt LE, Bernsmeier C, et al. High-volume plasma exchange in patients with acute liver failure: An open randomised controlled trial. J Hepatol 2016; 64(1): 69-78.
[http://dx.doi.org/10.1016/j.jhep.2015.08.018] [PMID: 26325537]
[12]
Yu CB, Chen JJ, Du WB, et al. Effects of plasma exchange combined with continuous renal replacement therapy on acute fatty liver of pregnancy. Hepatobiliary Pancreat Dis Int 2014; 13(2): 179-83.
[http://dx.doi.org/10.1016/S1499-3872(14)60028-X] [PMID: 24686545]
[13]
Guo X, Wu F, Guo W, et al. Comparison of plasma exchange, double plasma molecular adsorption system, and their combination in treating acute-on-chronic liver failure. J Int Med Res 2020; 48(6)
[http://dx.doi.org/10.1177/0300060520932053] [PMID: 32552092]
[14]
Yao J, Li S, Zhou L, et al. Therapeutic effect of double plasma molecular adsorption system and sequential half-dose plasma exchange in patients with HBV-related acute-on-chronic liver failure. J Clin Apher 2019; 34(4): 392-8.
[http://dx.doi.org/10.1002/jca.21690] [PMID: 30758886]
[15]
Moreau R. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology 2013; 144(7): 1426-37.
[http://dx.doi.org/10.1053/j.gastro.2013.02.042]
[16]
Ye WJ, Li LJ, Yu HY, Zhang XP, Tian J, Bai MH. [Clinical research of plasma exchange with continuous veno-venous hemofiltration in treating mid- and late-stage chronic severe viral hepatitis B patients]. Zhonghua Gan Zang Bing Za Zhi 2005; 13(5): 370-3.
[PMID: 15918974]
[17]
Jalan R, Saliba F, Pavesi M, et al. Development and validation of a prognostic score to predict mortality in patients with acute-on-chronic liver failure. J Hepatol 2014; 61(5): 1038-47.
[http://dx.doi.org/10.1016/j.jhep.2014.06.012] [PMID: 24950482]
[18]
Premkumar M, Saxena P, Rangegowda D, et al. Coagulation failure is associated with bleeding events and clinical outcome during systemic inflammatory response and sepsis in acute-on-chronic liver failure: An observational cohort study. Liver Int 2019; 39(4): 694-704.
[http://dx.doi.org/10.1111/liv.14034] [PMID: 30589495]

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