Plasmadiafiltration in treatment of hepatitis B virus related acute-on -chronic liver failure: analysis of prognostic factors

Abstract

Abstract: Objective To investigate the efficacy and the prognostic factors of plasmadiafiltration treatment in hepatitis B virus (HBV) related acute-on-chronic liver failure (ACLF) patients.Methods Clinical data of 41 HBV-related ACLF patients in our department was retrospectively analyzed. According to the 3-month prognosis, patients were divided into survival group and death group, and the clinical parameters and laboratory tests were compared between the 2 groups. Chi square test and t test were applied for statistical analyses.Results Among these patients, levels of plasma prothrombin activity (PTA) (18.33±7.75 % vs 29.20±15.07 %; t=-3.826, P<0.05), total bilirubin (TBil) (445.66±209.67 μmol/L vs 396.88±151.78 μmol/L; t=2.042, P<0.05) and model for end-stage liver disease (MELD) score (32.08±6.75 vs 29.67±7.70; t=2.026, P<0.05) were significantly changed on day 3 after three subsequent treatments of plasmadiafiltration.There were 12 cases in survival group and 29 cases in death group. In survival group, the ratio of patients with cirrhosis at admission was lower than that in death group (16.7% vs 68.9%, χ²=7.351, P<0.05), while the ratio of hepatic encephalopathy showed no significant difference (83.3% vs 96.6%, χ²=0.672, P>0.05). The duration from diagnosis to plasmadiafiltration treatment was significantly shorter in survival group than that in death group (2.58±0.67 d vs 6.07±4.38 d; t=-4.167, P<0.05). Compared with survival group, death group showed higher ratio of stage Ⅱ and Ⅲ acute kidney injury (AKI) at baseline (65.5% vs 8.3%, χ²=8.711, P<0.05). After plasmadiafiltration therapy, the improvements of MELD score and PTA in the survival group were significantly higher than that in death group.Conclusion Plasmadiafiltration therapy can improve liver function and blood coagulation function in patients with HBV-related ACLF. Moreover, pre-existing with liver cirrhosis, liver failure for long course and serious AKI stage at admission might be indicators for poor prognosis after plasmadiafiltration therapy, while significant improvements of PTA and MELD score after therapy might suggest favorable prognosis.

Key words: Plasmadiafiltration, Hepatitis B virus, Acute-on-chronic liver failure, Prognosis

QIAN Zhi-ping, CHEN Nan, ZHANG Yu-yi, ZHANG Zheng-guo, ZOU Ying, ZHU Hui, GUO Hong-ying, WANG Jie-fei, MEI Xue. Plasmadiafiltration in treatment of hepatitis B virus related acute-on -chronic liver failure: analysis of prognostic factors[J]. Chinese Hepatolgy, 2017, 22(2): 111-115.

References

[1] 刘晓燕, 胡瑾华, 王慧芬, 等. 1977例急性、亚急性、慢加急性肝衰竭患者的病因与转归分析. 中华肝脏病杂志, 2008, 16: 772-775.
[2] Duan BW, Lu SC, Wang ML, et al. Liver transplantation in acute-on-chronic liver failure patients with high model for end-stage liver disease (MELD) scores: a single center experience of 100 consecutive cases. J Surg Res, 2013,183: 936-943.
[3] 韦秀甜, 雷学忠. 人工肝支持系统的应用现状.中华肝脏病杂志, 2015, 23: 471-474.
[4] Sarin SK, Kedarisetty CK, Abbas Z, et al. Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL) 2014 . Hepatol Int, 2014, 8: 453-471.
[5] 陈珍,李自琼,黄文祥,等. 肝衰竭血浆滤过透析应用进展.西部医学,2015,27: 1113-1115.
[6] 中华医学会感染病学分会肝衰竭与人工肝学组,中华医学会肝病学分会重型肝病与人工肝学组.肝衰竭诊治指南(2012年版). 实用肝脏病杂志, 2013, 16: 210-216.
[7] Angeli P, Gines P, Wong F, et al. Diagnosis and management of acute kidney injury in patients with cirrhosis:revised consensus recommendations of the International Club of Ascites.Gut, 2015, 64: 531-537.
[8] Shen Y, Wang WL, Wang B, et al. Survival benefits with artificial liver support system for acute-on-chronic liver failure: A time series-base Meta-analysis. Medicine, 2016, 95: e2506.
[9] 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: e58738.
[10] Tsuyoshi M.Yutaka E.Tomoharu S, et al.A case of acute hepatic insufficiency treated with novel plasma diafiltration for bridge use until liver transplantation.Ther Apher Dial,2002,6: 463-466.
[11] Nakae H, Eguchi Y, Saotome T, et al. Multicenter study of plasma dia itration in patients with acute liver failure. Ther Apher Dial, 2010, 14: 444-450.
[12] Nevens F, Laleman W. Arti cial liver support devices as treatment option for liver failure. Best Pract Res Clin Gastroenterol, 2012, 26, 17-26.
[13] Heemann U, Treichel U, Loock J, et al. Albumin dialysis in cirrhosis with superimposed acute liver injury: A prospective, controlled study. Hepatology, 2002, 36: 949-958.
[14] Katoonizadeh A, Laleman W, Verslype C, et al. Early features of acute-on-chronic alcoholic liver failure: a prospective cohort study. Gut, 2010, 59:1561-1569.
[15] Huang K, Hu JH, Wang HF, et al. Survival and prognostic factors in hepatitis B virus-related acute-on-chronic liver failure. World J Gastroenterol, 2011,17: 3448-3452.
[16] Arroyo V, Moreau R, Jalan R, et al. Acute-on-chronic liver failure: A new syndrome that will re-classify cirrhosis. J Hepatol, 2015, 62: S131-143.
[17] Blasco-Algora S, Masegosa-Ataz J, Gutiérrez-García ML, et al. Acute-on-chronic liver failure: Pathogenesis, prognostic factors and management. World J Gastroenterol. 2015, 21: 12125-12140.
[18] Fagundes C, Barreto R, Guevara M, et al. A modified acute kidney injury classification for diagnosisand risk stratification of impairment of kidney function in cirrhosis. J Hepatol, 2013, 59: 474-481.