Abstract: Objective To investigate the correlation between the ratio of pre-albumin to total bilirubin (PA/TB) and serum level of alpha-fetoprotein (AFP) and the efficacy and prognosis of sequential plasma exchange with dual plasma molecular adsorption system (DPMAS) in patients with hepatitis B related acute on chronic live failure (HBV-ACLF).Methods Sixty HBV-ACLF patients who underwent sequential plasma exchange with DPMAS were selected. Before and after the treatment, venous blood was collected to detect serum pre-albumin (PA), total bilirubin (TBil) and AFP, and PA/TB ratio was calculated. After 90 days of follow-up post treatment, the factors affecting the death of HBV-ACLF patients within 90 days and the value of PA/TB ratio and AFP in predicting death within 90 days of HBV-ACLF patients were analyzed.Results Within all the 60 patients that had accomplished the treatment of sequential plasma exchange with DPMAS, 25 cases improved, 35 cases did not improve, 39 cases died and 21 cases survived during the follow-up. After the treatment, serum TBIL level decreased (P<0.05), while PA, PA/TB ratio and AFP increased (P<0.05). The serum levels of PA, AFP and PA/TB in the improved group were (215.21±4.02)g/L,(220.12±7.95)ng/mL, and(38.05±1.54)respectively,which were higher than (204.92±5.06)g/L, (179.20±10.05) ng/mL, and (33.34±2.05) respectively, in the non-improved group (P<0.05). The serum TBil level was(4.51±0.36)mg/dl in the improved group, which was lower than(7.42±0.77)mg/dL in the non-improved group (P<0.05). Serum TBIL level in the death group was(7.15±0.69)mg/dL which was higher than(4.46±0.30)mg/dL in the survival group (P<0.05). Serum AFP and PA levels, ratio of PA/TB in the death group were (206.03±6.12)g/L,(183.83±15.21)ng/mL, and(32.94±1.39) respectively, which were lower than(215.12±3.26)g/L,(219.32±8.52)ng/mL, and(39.68±0.30)respectively, in the survival group (P<0.05). Hepatic encephalopathy, low AFP and low PA/TB ratio were the risk factors for death in HBV-ACLF patients within 90 days (P<0.05). The area under the curve (AUC) of the combined PA/TB ratio and AFP in predicting HBV-ACLF death within 90 days was 0.920, which was higher than that of PA/TB ratio (AUC=0.688) and AFP (AUC=0.685) alone (P<0.05).Conclusion Decreased PA/TB ratio and serum level of AFP are associated with poor efficacy and poor prognosis after sequential plasma exchange with DPMAs in HBV-ACLF patients, which can be used as prognostic evaluating markers of HBV-ACLF patients.

Key words: Pre-albumin, Total bilirubin, Alpha fetoprotein, Hepatitis B, acute on chronic live failure, Plasma exchange, dual plasma molecular adsorption system