Changes Of Serum Total Bilirubin With Prothrombin Acti Vity After Plasma Exchange In Patients With Liver Failure And Prognostic Factors

ObjectiveTo investigate the changes of total bilirubin(TBIL)and prothrombin activity(PT A)after plasma exchange(PE)in patients with liver failure,and to understand t he influencing factors that affect the prognosisMethodsA total of 47 patients of liver failure treated with artificial liver plasma excha nge who were admitted to top three hospitals in Anhui from February 2015 to August 2018 were retrospectively analyzed,and according to their prognosis o n week 12 after first PE,they were divided into death group with 25 patients and survival group with 22 patients.The data on age,sex,and laboratory mar kers(Albumin,TBIL,PTA,Cr,etc.)before and after PE and at admission wer e collected.Univariate analysis was performed on the collected data.The comp arison between count data groups was performed using the?~2test;the compari son between measurement data groups was performed using the t-test or the M ann-Whithey U test.Multi-factor analysis was performed on single-factor meani ngful indicators,and multi-factor analysis was performed using binary logistic r egression analysis.Correlation analysis was performed using Pearson test and F riedman M test was used to test the differences between multiple groups.Results The age,based MELD score,PTA rising level after PE,PTA rising rate after P E and the serum levels of PT,APTT,INR before PE in dead patients were sign ificantly higher than those in survived cases[(47.52±13.37)years vs(36.95±6.24)years,(33.53±6.09)scores vs(27.93±3.97)scores,(30.25±11.08)%vs(22.37±10.67)%,(1.71±1.32)vs(0.74±0.49),(35.27±15.67)s vs(24.32±6.67)s,(93.80±40.60)s vs(64.73±27.22)s,(3.18±1.65)vs(2.17±0.70),respectively,P<0.05 for all],while serum level of PTA at admission in dead patients were significantly lower than that in survived cases[(23.82±10.10)%vs(33.89±9.26)%,P<0.05];the hepatic encephalopathy was higher than that in survived cases[64.00%vs 27.27%,P<0.05].Multivariate logistic regression analysis showed that age and PTA before the first PE were independent risk factors for short-term prognosis of patients with liver failure.Linear regression analysis showed that there wa s a positive correlation between TBIL decrease after PE and TBIL before PE(r=0.87,P<0.05);the decrease rate of TBIL after PE was uncorrelated with T BIL before PE(P>0.05);the increase of PTA after PE was negatively correlat ed with preoperative PTA(r=0.706,P<0.05)and the increase rate of PTA aft er PE was also negatively correlated with preoperative PTA(r=0.712,P<0.05).ConclusionAge and PTA were independent risk factors for short-term prognosis of patient s with liver failure.The decrease of TBIL and the increase of PTA after plasm a exchange are correlated with TBIL and PTA before plasma exchange,and th e decrease rate of TBIL is highly stable.