Efficacy Comparison And Analysis Of Prognostic Elements Of Different Artificial Liver Models In Hbv-Associated Treatment With Acute-on-Chronic Liver Failure

Background and Purpose Liver failure is a general term for a type of severe liver disease,with high mortality and poor prognosis in clinical practice.If active and effective treatment cannot be taken,it will bring misfortune to patients,add heavy economic burden and mental stress to families,and bring heavy economic burden to society.The condition of liver disease in China is different from that in Europe and the United States.Alcoholic and fatty liver failure are the main causes in Europe and the United States.Hepatitis virus infection is the most common cause in Chinese patients,of which hepatitis caused by hepatitis B virus is the most common.HBV-ACLF is one of the more common types of liver failure caused by HBV infection.Artificial liver,medical treatment and late liver transplantation are mostly used in the treatment of liver failure.Due to the low benefit of conservative medical treatment,liver transplantation is limited by the lack of liver source and high economic cost.Combined with clinical practice and patient economic situation,artificial liver treatment is mostly used in clinical practice,and there are many artificial liver treatment modes.Combined with the actual situation of our hospital,this study mainly discusses the therapeutic effect comparison and disease development prognostic factors analysis of total plasma exchange and "low plasma exchange + bilirubin adsorption" two different modes of artificial liver in the treatment of severe liver organ dysfunction associated with viral B,compares the differences between the two treatment modes,finds the factors affecting the prognosis of patients,and provides theoretical and clinical basis for HBV-ACLF patients undergoing artificial liver treatment.METHODS: A total of 148 patients with HBV-related chronic plus acute liver failure admitted to our hospital and a tertiary care hospital from January 2018 to July 2021 were collected and divided into PE LPE + DPMAS group（n = 81）and LPE + DPMAS group（n = 67）according to different artificial liver treatment modes.Due to different disease severity,52 patients were matched according to total bilirubin and plasma prothrombin activity.The clinical data of patients with basically the same disease condition after matching were obtained.Among them,48 patients received total plasma exchange（PE）treatment and 48 patients received dual plasma molecular adsorption system（DPMAS）sequential hypovolemic exchange plasma exchange（LPE）combined treatment.Various laboratory test indicators before the first artificial liver and before discharge and survival at 4 weeks after hospitalization were collected for statistical analysis.The 4-week survival rate was compared between the two groups.Binary logistic regression analysis was performed to investigate the influencing factors of4-week survival rate in HBV-ACLF patients.Results: Among 96 eligible patients,the laboratory indicators TBIL,GGT,BUN,ALT and AST in the two groups after treatment were improved compared with those before treatment（P < 0.05）,and there was no significant difference in the clinical data between the two groups after treatment（P > 0.05）;the coagulation indicators including PT,INR and PTA in the PE group were improved compared with those before treatment（P <0.05）,PT,INR and PTA in the LPE + DPMAS group were not significantly different from those before treatment（P > 0.05）;there was no significant difference in ALP,ALB,Cr,WBC and Na between the two groups before and after treatment（P > 0.05）,Hb and Plt in the two indicators of blood routine decreased after treatment compared with those before treatment,and there was no significant difference in the clinical data between the two groups after treatment（P > 0.05）;there was no significant difference in the 4-week survival rate between the two groups（P > 0.05）.Univariate analysis showed significant differences in AST,ALT,TBIL,ALB,PT,INR,PTA,WBC,and liver organ failure score Meld score between the 4-week survival and death groups,and binary logistic regression analysis showed that WBC was an independent risk factor affecting 4-week death.Conclusion: Ninety-six eligible HBV-ACLF patients included in this study were equally divided into two groups.The severity of the two groups was basically the same before treatment.After different modes of treatment,there was no significant difference in the 4-week survival rate between the two groups.The DPMAS + LPE alone group saves plasma and can reduce the burden on patients.For the society,it can save medical resources.The former is preferred.The regression analysis suggests that white blood cells are an independent risk factor affecting the 4-week death,which may be related to inflammatory infection.Therefore,it is necessary to monitor the white blood cell count during the treatment.