A prognostic score for patients with acute-on-chronic liver failure treated with plasma exchange-centered artificial liver support system

Abstract

Artificial liver support system (ALSS) therapy is widely used in patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). We aimed to develop a predictive score to identify the subgroups who may benefit from plasma exchange (PE)-centered ALSS therapy. A total of 601 patients were retrospectively enrolled and randomly divided into a derivation cohort of 303 patients and a validation cohort of 298 patients for logistic regression analysis, respectively. Five baseline variables, including liver cirrhosis, total bilirubin, international normalized ratio of prothrombin time, infection and hepatic encephalopathy, were found independently associated with 3-month mortality. A predictive PALS model and the simplified PALS score were developed. The predicative value of PALS score (AUROC = 0.818) to 3-month prognosis was as capable as PALS model (AUROC = 0.839), R score (AUROC = 0.824) and Yue-Meng’ score (AUROC = 0.810) (all p > 0.05), and superior to CART model (AUROC = 0.760) and MELD score (AUROC = 0.765) (all p < 0.05). The PALS score had significant linear correlation with 3-month mortality (R2 = 0.970, p = 0.000). PALS score of 0–2 had both sensitivity and negative predictive value of > 90% for 3-month mortality, while PALS score of 6–9 had both specificity and positive predictive value of > 90%. Patients with PALS score of 3–5 who received 3–5 sessions of ALSS therapy had much lower 3-month mortality than those who received 1–2 sessions (32.8% vs. 59.2%, p < 0.05). The more severe patients with PALS score of 6–9 could still benefit from ≥ 6 sessions of ALSS therapy compared to ≤ 2 sessions (63.6% vs. 97.0%, p < 0.05). The PALS score could predict prognosis reliably and conveniently. It could identify the subgroups who could benefit from PE-centered ALSS therapy, and suggest the reasonable sessions.Trial registration: Chinese Clinical Trial Registry, ChiCTR2000032055. Registered 19th April 2020, http://www.chictr.org.cn/showproj.aspx?proj=52471.

Lower level of IL‐28A as a predictive index of the artificial liver support system in effective treatment of patients with HBV‐ACLF

“…ALSS is widely used to bridge patients with liver failure to liver regeneration or liver transplantation when they were waiting liver source and reported to be effective in removing toxins of patients. 19 The 90‐day survival probability of HBV‐ACLF patients treated by ALSS was approximately 50.0%–60.0%, 4 , 20 , 21 which is consistent with our result (57%). And more and more studies succeeded to demonstrate that ALSS can improve survival rate of HBV‐ACLF patients.…”

“… 4 , 21 , 22 Early prediction of the treatment effect of ALSS on ACLF patients is important for clinicians to make timely and accurate therapeutic decision. Novel models 20 , 23 comprising four (number of complications, age, scores of the model for end‐stage liver disease and type of ALSS) or five (liver cirrhosis, total bilirubin, INR, infection, and hepatic encephalopathy) variables were constructed to discriminate survival in ACLF patients treated with ALSS. The former was related to ACLF patients with HBV as prevailing etiology and the latter focused on HBV‐ACLF only.…”

“…Novel models 20,23 HBV-ACLF who may benefit from ALSS therapy. However, none of these studies was associated with cytokines that was related not only to the prognosis of patients with HBV-ACLF but also to the effectiveness of ALSS treatment of HBV-ACLF.…”

A multi-subgroup predictive model based on clinical parameters and laboratory biomarkers to predict in-hospital outcomes of plasma exchange-centered artificial liver treatment in patients with hepatitis B virus-related acute-on-chronic liver failure

“…At admission, patients who survived ACLF were characterized by lower APTT, age, D-dimer, pulse, TBil, and higher ALT. Although the correlation between age and outcomes was not found in some studies (Du et al, 2021), our study does find that age is an independent prognostic risk factor for patients with HBV-ACLF, along with other studies (Wu et al, 2018;Xie et al, 2020);. The possible correlation between INR and prognosis was not found in our study, even though INR was reported to be an independent risk factor in predicting the development of HBV-ACLF (Du et al, 2021).…”

“…Although the correlation between age and outcomes was not found in some studies (Du et al, 2021), our study does find that age is an independent prognostic risk factor for patients with HBV-ACLF, along with other studies (Wu et al, 2018;Xie et al, 2020);. The possible correlation between INR and prognosis was not found in our study, even though INR was reported to be an independent risk factor in predicting the development of HBV-ACLF (Du et al, 2021). In the present study, patients who did not survive ACLF had higher TBil and lower ALT; this finding suggests that when the disease becomes severe, many liver cells die, the liver's ability to produce ALT is lost, and bilirubin levels rise.…”