Short-term efficacy of dual plasma molecular adsorption combined with glucocorticoid in the treatment of severe acute drug-induced liver injury

Abstract

Abstract: Objective To investigate the short-term efficacy of dual plasma molecular adsorption system (DPMAS) combined with glucocorticoids (GCs) in the treatment of severe acute drug-induced liver injury (DILI).Methods A total of 69 DILI patients admitted to Haian Hospital affiliated to Nantong University from January 2019 to march 2021 were randomly divided into observation group (n=31) and control group (n=38) by random number table method. DPMAS combined with GCs or DPMAS alone were used to treat the two groups of patients, respectively. Biochemical indexes, bilirubin rebound, liver reserve function, clinical efficacy and adverse reactions were compared before and after treatment.Results When compared the serum total bilirubin (TBil), direct bilirubin (DBil), alanine aminotransferase (ALT), prothrombin total activity (PTA), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and c-reactive protein (CRP) levels between the two groups of patients at 1 week and 2 week after treatment, the differences were statistically significant (P<0.05). Prothrombin time (PT) was lower than that of before treatment, and there was no significant difference within groups (P>0.05). The levels of TBil and DBil in the observation group increased slightly at 4 day and 8 day after treatment, but at the end of treatment, 4 day and 8 day after treatment, the levels in the observation group were significantly lower than those in the control group (P<0.05). The liver reserve function, effective circulating blood volume, model of end-stage liver disease (MELD) score and DPMAS times in the observation group were lower than those in the control group after treatment, the differences were statistically significant (P<0.05). The total effective rate of observation group was significantly higher than control group, and the difference was statistically significant (P<0.05). There were no significant differences in the incidence of acute liver failure and 6-month survival rate between the two groups (P>0.05). The DILI grading of both groups was significantly improved after treatment compared with before treatment, and the improvement degree of observation group was better than that of control group (P<0.05). There was no statistical significance in the incidence of adverse reactions between the two groups (P>0.05).Conclusion DPMAS combined with GCs can significantly improve the clinical symptoms and liver function of patients with severe DILI, and the effect time and improvement degree are higher than those of DPMAS alone.

Key words: Severe drug-induced liver injury, Double plasma molecular adsorption, Glucocorticoid, Liver reserve function, Bilirubin rebounds

DING Peng, ZHONG Hai-feng. Short-term efficacy of dual plasma molecular adsorption combined with glucocorticoid in the treatment of severe acute drug-induced liver injury[J]. Chinese Hepatolgy, 2022, 27(11): 1198-1202.

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