Assessing the clinical efficacy of low‐volume therapeutic plasma exchange in achieving recovery from acute liver failure induced by yellow phosphorous poisoning

Abstract

BackgroundAcute liver failure (ALF) following yellow phosphorous (YP) ingestion is similar to acetaminophen‐induced ALF and it has become a public concern in our region. This study assessed low volume therapeutic plasma exchange (LV‐TPE) efficacy in improving the transplant free survival in YP poisoning.MethodsAdult patients with toxicology reports of YP and ALF requiring critical care were included in the study. LV‐TPE was planned for three consecutive days and three more if required. Performed 1.3 to 1.5 plasma volume replacing with 0.9% normal saline, 5% human albumin solution, and fresh frozen plasma based on ASFA 2019 criteria. MELD score, laboratory parameters, LV‐TPE details were captured. The study end point was clinical outcome of the patients.ResultsAmong 36 patients, 19 underwent LV‐TPE and 17 opted out of LV‐TPE and they were included as a control arm. The MELD score was 32.64 ± 8.05 and 37.83 ± 9.37 in both groups. There were 13 survivors in LV‐TPE group leading to a 68.42% reduction in mortality. The coagulation and biochemical parameters showed a significant percentage change after LV‐TPE. Refractory shock, delay in initiating procedure and acidosis were independent predictors of mortality.ConclusionA well‐timed LV‐TPE improves the survival of patients with ALF due to YP poisoning.