Abstract: Objective To observe the efficacy of three different modes of non-bioartificial liver, which are dual plasma molecular adsorption (DPMAS), plasmapheresis (PE), and dual plasma molecular adsorption combined with low volume plasmapheresis (DPMAS+LPE) three different modes of non-bioartificial liver in the treatment of liver failure: dual plasma molecular adsorption (DPMAS) plasmapheresis (PE) and dual plasma molecular adsorption combined with low volume plasmapheresis (DPMAS+LPE).Methods A total of 109 patients with liver failure treated with non-bioartificial liver were selected as the research objects, and their clinical data were retrospectively collected. According to the different modes of artificial liver supporting system that they received for treatments, the patientsy were divided into three groups: dual plasma molecular adsorption (DPMAS) group, plasma exchange (PE) group, and dual plasma molecular adsorption combined with low volume plasma exchange (DPMAS+LPE) group. To compare tThe efficacy of artificial liver therapy in 3 groups of patients were compared. Results Total bilirubin (TBil) (284.65±89.90, 218.10±73.7, t=6.345; 256.73±98.53, 194.41±89.91, t=9.374; 245.63±60.75, 176.26±49.72, t=9.413, all P=0.0001), direct bilirubin (DBil) (195.52±86.36, 152.97±69.22, t=5.297; 182.81±86.03, 113.42±64.74, t=5.630; 170.56±46.22, 125.64±41.38, t=8.107, all P=0.0001) and alanine aminotransferase (ALT) [109.50 (33.25～342.50), 101.50(28.75～208.25), Z=-3.198, P=0.001; 86.00 (35.50～199.00), 64.00 (36.50～133.00), Z=-3.751, P=0.0010; 49.00 (30.00～123.75), 37.50 (27.75～101.25), Z=-3.324, P=0.001] in 3 groups of patients decreased significantly within 24 h after the first non-bioartificial liver treatment. Albumin (Alb) level in PE group increased significantly after treatment (31.25±5.33, 32.87±7.11, t=-2.200, P=0.034). In DPMAS group, Hemoglobin (Hb) (96.47±18.48, 84.88±23.82, t=3.919, P=0.0001) and Fibrinogen (FIB) (2.36±2.02, 1.67±0.89, t=2.764, P=0.009) decreased significantly after treatment. Pairwise comparison between groups: The decline rate of MELD score in the PE group [0.13 (0.09～0.27) ] and DPMAS+LPE group [0.19 (0.12～0.24)] was significantly higher than that in the DPMAS group [0.05 (0.00～0.11)] (P<0.05). The decline rate of prothrombin time (PT) in the PE group [0.21 (0.11～0.35)] and DPMAS+LPE group [0.18 (0.10～0.32)]was significantly higher than that in the DPMAS group[0.00 (-0.13～0.10)] (P<0.05). The decline rate of international normalized ratio (INR) in the PE group [0.19 (0.11～0.39)] and DPMAS+LPE group [0.21 (0.13～0.32)]was significantly higher than that in the DPMAS group[0.02 (-0.11～0.11)] (P<0.05). The reduction rate of white blood cell (WBC) in the PE group [0.14 (-0.05～0.34)] and DPMAS+LPE group [0.15 (-0.05～0.34)] was significantly higher than that in the DPMAS group [0.01 (-0.30～0.11)] (P<0.05). The reduction rate of neutrophil-lymphocyte ratio (NLR) in the PE group [0.26 (-0.07～0.45)] and DPMAS+LPE group [0.21 (0.16～0.46)] was significantly higher than that in the DPMAS group [-0.14 (-0.84～0.09)] (P<0.05).The decline rate of prothrombin activity (PTA) in DPMAS group [0.00 (-0.17～0.12)] was significantly higher than that in PE group [-0.46 (-1.09～-0.23)] and DPMAS+LPE group [-0.35 (-0.81～-0.16)], respectively. There was no significant difference in the above indexes between PE group and DPMAS+LPE group (P＞0.05) . The decrease of procalcitonin (PCT) in DPMAS+LPE group was the most significant [0.08 (-0.09～0.27), 0.29 (0.13～0.42), 0.48(0.34～0.69), KW=30.935, P<0.0001]. There was no significant difference in survival rate among the three groups (47.1%, 54.1%, 60.5%, χ²=1.953, P=0.377). Conclusion DPMAS, PE and DPMAS+LPE can improve liver function into different degreeextents. PE and DPMAS+LPE can effectively improve coagulation function and inflammatory response. DPMAS can reduce Hb and FIB. There was no significant difference in survival rate among patients treated with the three non-biological artificial liver systems.

Key words: Artificial liver, Plasma exchange, Liver failure