Therapeutic Effects And Health Economic Analyses Of Double Plasma Molecular Adsorption System (DPMAS) For Acute Liver Failure

Objective: To investigate the therapeutic effects and conduct the health economic analyses of double plasma molecular adsorption system(DPMAS)for acute liver failure.Methods: This was a single center retrospective cohort study.Patients diagnosed with acute liver failure and treated with DPMAS and standard drug therapy in the Affiliated Hospital of Inner Mongolia Medical University from January 2016 to October 2020 were collected as the treatment group.At the same time,cases with the same diagnosis in the same period but receiving standard drug therapy only were selected and the same number of cases were chosen among them to match with the treatment group by 1:1 according to age,gender,cause of liver injury and degree of liver injury at admission as the control group.The levels of alanine aminotransferase(ALT),aspertate aminotransferase(AST),albumin(Alb),globulin(Glb),albumin/globulin(Alb/Glb),total bilirubin(TBi L),indirect bilirubin(IBi L),direct bilirubin(DBi L),alkaline phosphatase(ALP),total bile acid(TBA),gamma-glutamyl transpeptidase(GGT)and so on were collected at different time points.At the same time,7-month survival data were collected and the survival rate of the two groups was compared,and the survival curve was drawn to estimate the impact of DPMAS treatment on the prognosis of the patients.The hospital fees of the two groups were compared for health economic analyses.Results: 1.Fourteen patients in the treatment group met the conditions and 14 patients who received simple drug treatment in the same period were selected as the control group.Altogether,14 patients in treatment group were treated with DPMAS for 30 times,of which 1patient died of cardiac and respiratory arrest during treatment.2.Among the 28 patients,16 were male and 12 were female.The main cause of the disease was drug or poison injury,accounting for 57.14%.The median(interquartile range)age was 58(47.00-72.50)years old.Four patients were complicated with hepatic encephalopathy and 11 patients were complicated with infection.There was no significant difference in demographic data,biochemical indexes,Child Pugh score and MELD score between the two groups before the therapy(P > 0.05).3.The biochemical indexes at each time point in hospital were compared between the treatment group and the control group and no significant difference was found in AST/ALT,Alb,Alb/Glb,TBA until the 14 th day(P > 0.05).Besides,it was observed that either drug treatment alone or combined with DPMAS could improve jaundice symptoms,reduce bilirubin and bile acid,and improve liver function,but it was confirmed that there was no difference between the two groups(P > 0.05).4.The biochemical indexes were compared before and after the first therapy in the treatment group.The TBi L,DBi L and GGT in the treatment group decreased significantly,prothrombin time(PT)and international normalized ratio(INR)increased significantly(P <0.05),but there was no significant difference in the levels of serum kalium and serum sodium.5.The biochemical indexes in the treatment group at each time point before and after therapy were compared.The concentrations of TBi L,DBi L and IBi L in the treatment group decreased significantly until the 14 th day after first DPMAS treatment(P < 0.01),ALT and AST decreased significantly(P < 0.05),and Glb,ALP,GGT did not decrease significantly until the 10 th day after the first DPMAS treatment(P < 0.05).6.Kaplan Meier curve showed that the 7-month survival rates of treatment group and control group were 57.1% and 71.4% respectively.Log rank test showed no significant difference was found between the two groups [HR: 1.538(0.445-5.313);P = 0.484].7.In treatment group,the hospitalization cost was higher than that in control group(P <0.001),but no significant difference was found in hospital length of stay between the two groups(P > 0.05).Conclusions: DPMAS combined with drug therapy could not significantly improve the biochemical indexes related to liver function and long-term prognosis compared with drug therapy alone,but the cost of DPMAS treatment was huge.