Prognosis of acute-on-chronic liver failure patients treated with artiﬁcial liver support system

Zhou, Ping; Zheng, Shuang; Yu, Ming; He, Shengsong; Weng, Zhihong

doi:10.3748/wjg.v21.i32.9614

Cited by 27 publications

(19 citation statements)

References 37 publications

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“…Pre-existent research showed that ALT and AST show not correlation with the severity or prognosis of HBV-related ACLF and prophase HBV-related liver failure. [ 28 – 30 ] In the present research, ALT and AST were also not independent influencing factors of ACLF occurrence in patients with AD of HBV-related CLD. ALT and AST rapidly and easily decreased, which was observed by clinicians because of the medical treatment given to patients and the bilirubin–enzyme separation phenomenon.…”

Section: Discussioncontrasting

confidence: 57%

Prediction model of the progression of patients with acute deterioration of hepatitis B virus-related chronic liver disease to acute-on-chronic liver failure

Zhu

et al. 2018

Medicine

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This study aimed to establish a new model for predicting acute-on-chronic liver failure (ACLF) (defined by the Chinese Medical Association), which potentially occurs among patients with acute deterioration (AD) of hepatitis B virus (HBV)-related chronic liver disease (CLD).A total of 754 patients with AD of HBV-related CLD (total bilirubin (TBIL) > 51.3 μmol/L and prothrombin activity (PTA) < 60%, 40% < PTA < 60% when TBIL ≥ 171.1 μmol/L) were retrospectively analyzed and divided into a training cohort (580 patients) and a validation cohort (174 patients). The ACLF occurrence probability of these patients was statistically analyzed within 4 weeks. In the training cohort, multivariate logistic regression analysis was performed to determine the independent predictors of ACLF occurrence and to develop a new prediction model. The validation cohort was utilized to verify and evaluate the value of the new prediction model.Within 4 weeks, 9.9% of the patients progressed to ACLF (12.0 ± 6.7 days). The new prediction model was characterized by R = 3.090 + 0.035 × Age (years) − 0.050 × PTA (%) + 0.005 × TBIL (μmol/L) + 0.044 × D/T (%) − 0.072 × Na (mmol/L) + 0.180 × HBV DNA (log10IU/mL). The areas under the receiver operating characteristic curves of the training and validation cohorts in the new model were higher than those in the model for end-stage liver disease.The new prediction model could be used by clinicians to recognize patients with AD of HBV-related CLD with high risks of progressing to ACLF.

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Section: Discussioncontrasting

confidence: 57%

Prediction model of the progression of patients with acute deterioration of hepatitis B virus-related chronic liver disease to acute-on-chronic liver failure

Zhu

et al. 2018

Medicine

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“…PE has been widely used in China due to its ability to rapidly remove over‐accumulated toxic materials and replace beneficial plasma substances . Although PE alone is useful, combining PE with other purification methods is even more effective . It was reported that if MELD score could be reduced prior LT, the prognosis of HBV‐ACLF could be improved .…”

Section: Discussionmentioning

confidence: 99%

A prognostic model for hepatitis B acute‐on‐chronic liver failure patients treated using a plasma exchange‐centered liver support system

Xie

Violetta

Chen

et al. 2019

J of Clinical Apheresis

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Aim: To determine the prognostic risk factors of patients with hepatitis B virus related acute-on-chronic liver failure (HBV-ACLF) treated with plasma exchange (PE)-based artificial liver support system (ALSS), and create a prognostic predictive model. Methods:A total of 304 HBV-ACLF patients who received PE-based ALSS were retrospectively analyzed. Potential prognostic factors on admission associated with survival were investigated. Of note, 101 additional patients were analyzed to validate the performance of the prognostic models.Results: According to 28-day survival, a total of 207 patients who survived and 97 non-survivors were identified in the derivation group. Overall, 268 (88.2%) ACLF cases were caused by reactivation of HBV. Cox proportional hazards regression model revealed that age, total bilirubin, ln (alphafetoprotein [AFP]), encephalopathy (HE) score, sodium level, and international normalized ratio (INR) were independent risk factors of short-term prognosis. We built a model named ALSS-prognosis model (APM) to predict the 28-day survival of HBV-ACLF patients with ALSS; the model APM showed potentially better predictive performance for both the derivation and validation groups than MELD, MELD-Na, and CLIF-C ACLF score.Conclusions: Low AFP was found to be an independent risk factor for high mortality in HBV-ACLF patients treated with PE-based ALSS. We generated a new model containing AFP, namely APM, which showed potentially better prediction performance than MELD, MELD-Na, and CLIF-C ACLF score for short-term outcomes, and could aid physicians in making optimal therapeutic decisions. K E Y W O R D S AFP, ALSS, HBV-ACLF, plasma exchange Zhongyang Xie and Laurencia Violetta contributed equally to this study.

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“…In the past, the dose was usually set to one total plasma volume, which was approximately 5% of body weight (approximately 3,000 mL) [ 22 ]. Due to the shortage of plasma in recent years and a retrospective study suggesting that plasma adsorption plus PE therapy could reduce the amount of plasma needed for PE therapy without impairing the therapeutic efficiency [ 23 ], plasma adsorption plus PE with half the total plasma volume (approximately 1,500 mL) is now widely used for ALSS therapy in China.…”

Section: Methodsmentioning

confidence: 99%

Good Tolerance of Citrate Accumulation due to Plasma Exchange among Patients with Acute-on-Chronic Liver Failure: A Prospective, Observational Study

Chen

et al. 2018

Canadian Journal of Gastroenterology and Hepatology

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Aim To assess the tolerance of citrate accumulation due to plasma exchange (PE) among patients with acute-on-chronic liver failure (ACLF). Methods A prospective, observational study was conducted among patients with ACLF who received heparin anticoagulation during PE-centered therapy without filtration and dialysis. Citrate accumulation was defined as the value of total calcium (Catot) to ionized calcium (Caion) ratio (Catot/Caion) greater than or equal to 2.5 (Catot/Caion ≥ 2.5). Results Fifty-four patients were enrolled. The mean age and MELD score were 50.0 ± 11.3 years old and 25 ± 7, respectively. Thirty-three patients had liver cirrhosis. The total 3-month survival rate was 57.4% (31/54). The mean Catot/Caion at the time before PE was 2.05 ± 0.14. Catot/Caion ≥ 2.5 occurred in 100.0% (54/54) and 29.6% (16/54) of patients with mean Catot/Caion of 4.34 ± 1.52 and 2.36 ± 0.32 immediately after PE and 1 hour after PE, respectively, and these levels were much higher than those before PE (p < 0.01). However, all values returned to lower than 2.5 by the next morning with no difference from those before PE (2.10 ± 0.14 versus 2.05 ± 0.14, p > 0.05). Hypocalcemia (ionized calcium) and mild alkalosis were the main metabolic alterations. No symptoms associated with hypocalcemia occurred. Conclusions Citrate accumulation is well tolerated by patients with ACLF who receive PE-centered therapy without filtration and dialysis. This study is regeristed with ChiCTR-OOC-17013618.

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Prognosis of acute-on-chronic liver failure patients treated with artiﬁcial liver support system

Abstract: A novel model was constructed to predict prognosis and accurately discriminate survival in ACLF patients treated with an artiﬁcial liver support system.

Cited by 27 publications

References 37 publications

Prediction model of the progression of patients with acute deterioration of hepatitis B virus-related chronic liver disease to acute-on-chronic liver failure

Prediction model of the progression of patients with acute deterioration of hepatitis B virus-related chronic liver disease to acute-on-chronic liver failure

A prognostic model for hepatitis B acute‐on‐chronic liver failure patients treated using a plasma exchange‐centered liver support system

Good Tolerance of Citrate Accumulation due to Plasma Exchange among Patients with Acute-on-Chronic Liver Failure: A Prospective, Observational Study

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