Plasma Exchange-Based Non-bioartificial Liver Support System Improves the Short-Term Outcomes of Patients With Hepatitis B Virus-Associated Acute-on-Chronic Liver Failure: A Multicenter Prospective Cohort Study

• Published in: Frontiers in medicine Vol. 8; p. 779744
• Main Authors: Chen, Yuan-Yuan, Li, Hai, Xu, Bao-Yan, Zheng, Xin, Li, Bei-Ling, Wang, Xian-Bo, Huang, Yan, Gao, Yan-Hang, Qian, Zhi-Ping, Liu, Feng, Lu, Xiao-Bo, Shang, Jia, Wang, Shao-Yang, Zhang, Yin-Hua, Meng, Zhong-Ji
• Format: Journal Article
• Language: English
• Published: Frontiers Media S.A 16-11-2021
• Subjects: acute-on-chronic liver failure; hepatitis B virus; Medicine; plasma exchange; propensity score matching; survival rate
• ISSN: 2296-858X; 2296-858X
• DOI: 10.3389/fmed.2021.779744

Background and aims:
Hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF) is a complicated syndrome with extremely high short-term mortality. Whether plasma exchange (PE) improves HBV-ACLF outcomes remains controversial. Here, PE-based non-bioartificial liver support system (NB-ALSS) effects on short-term HBV-ACLF patient outcomes were investigated.
Materials and methods:
HBV-ACLF patients from Chinese Acute-on-chronic Liver Failure (CATCH-LIFE) cohort receiving standard medical therapy (SMT) alone or PE-based NB-ALSS in addition to SMT were allocated to SMT and SMT+PE groups, respectively; propensity score matching (PSM) was used to eliminate confounding bias. Short-term (28/90-day and 1-year) survival rates were calculated (Kaplan-Meier).
Results:
In total, 524 patients with HBV-ACLF were enrolled in this study; 358 received SMT alone (SMT group), and the remaining 166 received PE-based NB-ALSS in addition to SMT (SMT+PE group). PSM generated 166 pairs of cases. In the SMT+PE group, 28-day, 90-day, and 1-year survival rates were 11.90, 8.00, and 10.90%, respectively, higher than those in the SMT group. Subgroup analysis revealed that PE-based NB-ALSS had the best efficacy in patients with ACLF grade 2 or MELD scores of 30–40 (MELD grade 3). In MELD grade 3 patients who received SMT+PE, 28-day, 90-day, and 1-year survival rates were improved by 18.60, 14.20, and 20.10%, respectively. According to multivariate Cox regression analysis, PE-based NB-ALSS was the only independent protective factor for HBV-ACLF patient prognosis at 28 days, 90 days, and 1 year (28 days, HR = 0.516,
p
= 0.001; 90 days, HR = 0.663,
p
= 0.010; 1 year, HR = 0.610,
p
= 0.051). For those who received SMT+PE therapy, PE-based NB-ALSS therapy frequency was the only independent protective factor for short-term prognosis (28-day, HR = 0.597,
p
= 0.001; 90-day, HR = 0.772,
p
= 0.018).
Conclusions:
This multicenter prospective study showed that the addition of PE-based NB-ALSS to SMT improves short-term (28/90 days and 1-year) outcomes in patients with HBV-ACLF, especially in MELD grade 3 patients. Optimization of PE-based NB-ALSS may improve prognosis or even save lives among HBV-ACLF patients.