Mixed mode of artificial liver support in patients with acute-on-chronic liver failure: a retrospective cohort study

作者全名："Wang, Xiao-hao; Peng, Bin-bin; Zhang, Lu; Zhao, Jing; Zhang, Li; Ren, Hong; Hu, Peng; Li, Hu; Zhong, Shan"

作者地址："[Wang, Xiao-hao; Peng, Bin-bin; Zhang, Lu; Zhao, Jing; Zhang, Li; Ren, Hong; Hu, Peng; Li, Hu; Zhong, Shan] Chongqing Med Univ, Affiliated Hosp 2, Inst Viral Hepatitis, Dept Infect Dis,Minist Educ,Key Lab Mol Biol Infec, 288 Tianwen Ave, Chongqing 401336, Peoples R China"

通信作者："Li, H; Zhong, S (通讯作者)，Chongqing Med Univ, Affiliated Hosp 2, Inst Viral Hepatitis, Dept Infect Dis,Minist Educ,Key Lab Mol Biol Infec, 288 Tianwen Ave, Chongqing 401336, Peoples R China."

来源：HEPATOLOGY INTERNATIONAL

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:001044178900001

JCR分区：Q1

影响因子：5.9

年份：2023

卷号：　

期号：　

开始页：　

结束页：　

文献类型：Article; Early Access

关键词：Acute-on-chronic liver failure; Artificial liver support; Plasma exchange; Double plasma molecular adsorption system; Plasma adsorption; Blood purification; Survival; Mortality; Prognosis; MELD

摘要："Background and aims Different modes of artificial liver support (ALS) therapy can improve the survival of patients with acute-on-chronic liver failure (ACLF). This study aimed to compare the effects of mixed using different modes of ALS (MALS) and single using one mode of ALS (SALS) on 28- and 90-day survival rates of ACLF. Methods Clinical data and survival times of patients with ACLF treated for ALS between January 1, 2018 and December 30, 2021 were retrospectively collected. Cox regression analysis was performed to identify risk factors of 28- and 90-day mortalities. Results Of the 462 eligible ACLF patients, 388 belonged to the SALS group (76.3% male, 74.2% cirrhosis) and 74 to the MALS group (86.5% male, 71.6% cirrhosis). Comparison of 28-day and 90-day crude mortality between the SALS and MALS groups showed no significant differences (28-day: 20.4% vs. 14.9%, p = 0.27; 90-day: 44.6% vs. 52.7%, p = 0.20). After adjusting for confounders, the 28-day mortality (adjusted hazard ratio [aHR]: 0.32, 95% confidence interval [CI] 0.16-0.65) and 90-day mortality (aHR: 0.65, 95% CI 0.44-0.95) in the MALS group were significantly lower than those in the SALS group. These associations were consistently observed across pre-specified subgroups according to age, sex, etiology, and Child-Pugh grade. However, positive interactions between MALS and 90-day mortality were found between MALS and 90-day mortality in those with MELD score >= 22 and international normalized ratio >= 1.9 (p for interaction < 0.05). Conclusion MALS therapy significantly decreased 28- and 90-day mortalities of ACLF than SALS did, especially in advanced stages."

基金机构："National Natural Science Foundation of China [82173237, 81902068]; Senior Medical Talents Program of Chongqing for Young and Middle-aged [[2022]15]; Program for Youth Innovation in Future Medicine, Chongqing Medical University [W0082]; Kuanren Talents Program of the Second~Affiliated Hospital of Chongqing Medical University; Remarkable Innovation-Clinical Research Project, the Second Affiliated Hospital of Chongqing Medical University; First batch of key Disciplines On Public Health in Chongqing, Health Commission of Chongqing, China"

基金资助正文："This work is supported by the National Natural Science Foundation of China (82173237, 81902068); Senior Medical Talents Program of Chongqing for Young and Middle-aged (No. [2022]15); Program for Youth Innovation in Future Medicine, Chongqing Medical University (W0082); Kuanren Talents Program of the Second & nbsp;Affiliated Hospital of Chongqing Medical University (Shan Zhong, Hu Li); Remarkable Innovation-Clinical Research Project, the Second Affiliated Hospital of Chongqing Medical University; The First batch of key Disciplines On Public Health in Chongqing, Health Commission of Chongqing, China."