Prediction Value of Model for End-Stage Liver Disease Scoring System on Prognosis in the Acute on Chronic Liver Failure Patients With Plasma Exchange Treatment

Abstract

Hepatitis B virus-related acute-on-chronic liver failure (AoCLF) is associated with a high mortality rate. Plasma exchange (PE) is useful to bridge patients with AoCLF to liver transplantation or recovery. The aim of this study was to analyze the impact of the model for end-stage liver disease (MELD) score on 30-day survival in patients with AoCLF treated with PE or conventional medications and to evaluate the therapeutic effectiveness of PE. In this study, 62 enrolled patients with AoCLF who received PE treatment were compared with 131 patients treated with conventional medications. The MELD scores were calculated according to the original formula, and the 30-day survival in patients was recorded. The 30-day survival rate of the patients who received PE versus controls was 41.9% versus 25.2% (p < 0.05). The 30-day survival rate of patients in the PE group (50.0%) with a MELD score from 20 to 30 was higher than that of the control group (31.7%, p < 0.05); for MELD scores more than 30, there was no significant difference in two groups (8.3% vs. 0%, p > 0.05). PE seems to be efficacious and safe for the treatment of patients with AoCLF and significantly increased the survival rates of patients with a MELD score of 20-30.

Clinical application of elevated platelet-activating factor acetylhydrolase in patients with hepatitis B

“…The MELD score is a prospectively developed and validated scale for the severity of end-stage liver disease that uses the quantitative, objective values of serum TBIL, serum creatinine, and INR of prothrombin time to predict patient mortality in patients with advanced liver disease [16,40]. Mao et al’s study reported that the MELD score was related to the prognosis of patients with HBV-related acute-on-chronic liver failure [41]. We found that although the AUC of PAF-AH was lower than the AUC of the MELD score for predicting CSHB, the AUC of PAF-AH combined with MELD score was higher than that of PAF-AH or the MELD score alone.…”

A single-center experience of non-bioartificial liver support systems among Chinese patients with liver failure

“…Nearly 90% of patients experience an improvement in symptoms such as fatigue or abdominal distension following NBAL therapy, and liver function parameters have been shown to improve significantly in all tested subjects (17,18). Additionally, NBAL can serve as a bridge to LT (19,20). NBAL treatment prior to LT improves perioperative conditions, reduces the incidence of post-transplant complications, and reduces early mortality (7).…”

Liver transplantation in acute-on-chronic liver failure

“…Replacement of the patients' plasma with its wide range of toxins and mediators by fresh frozen plasma is thought to facilitate liver regeneration and recovery. In each of the three studies summarised [ Table 1], [8][9][10] there was a statistically significant improvement either in survival or in the obtaining of a reduced MELD score prior to LT. I would ask you also to take note of the very recently published study of high volume plasma exchange in acute liver failure (ALF) showing in those not transplanted, significant survival improvement.…”