Abstract: Objective To evaluate whether the early application of artificial liver support therapy, combined with antibiotic treatment, enhances the anti-infective efficacy of antibiotics and promotes liver function recovery in patients with hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF) complicated by bacterial co-infection.Methods This study included patients with HBV-ACLF and bacterial co-infection admitted to the First Affiliated Hospital of Nanchang University between January 2019 and December 2022. Patientes were divided into two groups based on whether they received artificial liver support therapy(DPMAS+PE) within three days of confirmed infection alongside antibiotic treatment. The treatment group (n=44) received artificial liver support within three days, while the control group (n=39) did not. Key indicators, including procalcitonin (PCT), total bilirubin (TBil), prothrombin time (PT), international normalized ratio (INR), and infection control time(defined as PCT reduction to ≤80% of baseline or < 0.5 ng/mL), were compared between the two groups before and after artificial liver treatment.Results No statistically significant difference was observed in the reduction of PCT before and after artificial liver treatment between the two groups (treatment group: 0.42±0.32 ng/mL, control group: 0.50±0.30 ng/mL, P>0.05). However, the reduction in TBil was significantly greater in the treatment group compared to the control group (treatment group: 233.63±107.04 μmol/L, control group: 164.21±104.47 μmol/L, P<0.01). The treatment group also required fewer days for infection control than the control group (treatment group: 5.13±2.40 days, control group: 9.00±7.17 days, P<0.01). There was no significant difference in PT or INR between the two groups after treatment compared to baseline.Conclusion In patients with HBV-ACLF and bacterial co-infection, the combination of antibiotics and early artificial liver support therapy (within 3 days of confirmed infection) leads to a significant reduction in PCT levels compared to baselinet. Early application of artificial liver therapy does not interfere with the the anti-infective efficacy of antibiotics or exacerbate the infection, and it helps recude the duration of antibiotic use, thereby facilitating more effective infection control. Additionally, early artificial liver support effectively limits the progression of liver failure, significantly reduces bilirubin levels, and promotes liver function recovery.

Key words: Hepatitis B virus, Acute-on-chronic liver failure, Infections, Artificial liver support