Plasma exchange-centered artiifcial liver support system in hepatitis B virus-related acute-on-chronic liver failure：a nationwide prospective multicenter study in China

摘要

BACKGROUND: Plasma exchange (PE)-centered artiifcial liver support system reduced the high mortality rate of hepa-titis 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 eval-uated 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), ifbrinogen (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 signiifcantly 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 pa-tients with HBV-ACLF. Levels of TB, Cr and PT, age and disease stage help to predict prognosis.