Efficacy Of Dual Plasma Molecular Adsorption System Combined With Sequential Half-dose Plasma Exchange In The Treatment Of Patient Of Early And Middle Stage Liver Failure

Objective:To compare simple Plasma exchange(PE)with Dual plasma molecular adsorption system(DPMAS).To evaluate the short-term efficacy and long-term survival rate of DPMAS followed by half-dose plasma exchange(DPMAS+PE)in the treatment of early and middle stage liver failure.Methods:The information of patients with early and middle stage liver failure treated with artificial liver in our department was collected from January 2020 to December 2021.According to the artificial liver model,the patients were divided into PE group and DPMAS+PE group.The main outcome measures were the changes of liver function and coagulation indexes after treatment and the 4-week and 48-week liver transplantation-free survival rate.Multivariate Logistic regression analysis was used to study the factors affecting the death of patients with early and middle stage liver failure after artificial liver treatment.Results:1.A total of 67 patients were enrolled in this study,including 42 patients in the PE group and 25 patients in the DPMAS+PE group.Age(50.10±14.45vs50.02±13.90,P=0.979),gender(male 66.67%vs76.00%,P=0.419)and number of treatment(2.88±1.35vs3.10±1.01)were significantly different between the two groups P=0.446),etiology,liver function,coagulation index,blood routine,renal function,MELD score and liver failure stage were not statistically significant between the two groups.2.The changes of liver function before and after treatment were similar in the PE group and the DPMAS+PE group.The levels of ALT,AST,TBIL and DBIL 24 hours after treatment were significantly lower than those before treatment in the two groups.In the PE group,PT-S and INR after treatment were significantly lower than those before treatment,and PT% after treatment was significantly higher than that before treatment.In DPMAS+PE group,there were no significant changes in PT-S,PT% and INR before and after treatment.3.There was no significant difference in the immediate reduction rate of ALT,AST,TBIL and DBIL between the two groups after artificial liver treatment.The immediate decrease rate of PT-S and INR in the PE group was significantly higher than that in the DPMAS+PE group(17.62±13.94%vs0.96±13.26%,P=0.000;19.71±14.64%vs0.33±14.20%,P=0.000).4.The rebound rate of PT-S and INR in the PE group was higher than that in the DPMAS+PE group at 72 hours after treatment(26.96±29.52%vs3.00±14.62%,P=0.000;31.02±35.87%vs2.51±14.57%,P=0.000).At 72 hours after treatment,the TBIL rebound rate in the PE group was higher than that in the DPMAS+PE group(44.25±40.74%vs23.53±27.48%,P=0.028).There was no significant difference in the rebound rate of ALT and AST 72 hours after treatment between the two groups.5.After total treatment,the reduction rate of TBIL and DBIL in DPMAS+PE group was significantly higher than that in PE group(62.86±15.91%vs38.19±36.36%,P=0.000;65.85±16.53%vs45.03±29.58%,P=0.000).The reduction rate of INR in the PE group was significantly higher than that in the DPMAS+PE group(32.71±22.68%vs16.34±18.22%,P=0.005).There was no significant difference in the decline rate of PT-S,ALT and AST between the two groups(P>0.05).6.The liver transplantation-free survival rate was 54.76%(23/42)in PE group and 80.00%(20/25)in DPMAS+PE group at 4 weeks after treatment,and the difference was statistically significant(log-rank test X2=4.72,P=0.030).Liver transplantation-free survival rate was 37.50%(12/32)in the PE group and 66.67%(14/21)in the DPMAS+PE group at week 48,and the difference was statistically significant(log-rank test X2=4.32,P=0.038).Median follow-up was 56 weeks,minimum follow-up was 19 weeks,and maximum follow-up was 101 weeks.Among them,53 patients were followed up for 48 weeks.7.TBIL after the last treatment(average 3.10 times,OR=5.49,95%CI=1.15-26.27,P=0.033),INR after the last treatment(OR=12.15,95%CI=2.37-62.14,P=0.033),P=0.003)were the factors affecting the death of patients with early and middle stage liver failure after artificial liver treatment.8.During the whole treatment,there were no serious adverse reactions related to artificial liver in the two groups.Conclusion:Compared with PE alone,DPMAS+PE can effectively improve the bilirubin level and the 48-week liver transplantation free survival rate of patients with early and middle stage liver failure.TBIL after the last artificial liver treatment is an independent influencing factor for the prognosis of patients with early and middle stage liver failure after artificial liver treatment.Therefore,DPMAS+PE is likely to be an effective means for patients with early and middle stage liver failure.