Effect of artificial liver support system on short‐term prognosis of patients with hepatitis B virus‐related acute‐on‐chronic liver failure

Liu, Hua; Zhang, Qian; Liu, Lei; Cao, Yingying; Ye, Qing; Liu, Fang; Liang, Jian; Wen, Jing; Li, Ying; Han, Tao

doi:10.1111/aor.13710

Cited by 16 publications

(26 citation statements)

References 48 publications

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“…The mortality of patients treated with SMT only is about 3 times that of patients treated with ALSS. As described before, organ failures were associated with the severity and outcome of ACLF [ 32 , 36 ]. Also, according to the mechanism of ALSS, it could rapidly improve organ function.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Artificial Liver Support System on Prognosis of HBV-Derived Hepatorenal Syndrome: A Retrospective Cohort Study

Sheng

Zhou

et al. 2022

Disease Markers

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Hepatorenal syndrome (HRS) could occur when patients get decompensated liver cirrhosis. Meanwhile, hepatitis B virus (HBV) infection raises the risk of mortality of the end-stage liver diseases. As the artificial liver support system (ALSS) has been applied in liver failure, whether ALSS could benefit HBV-derived HRS remains uncertain. We retrospectively enlisted eligible HRS patients and compared the baseline characteristics and prognosis between HBV-derived HRS and non-HBV-derived HRS. Furthermore, propensity score matching (PSM) and Cox regression analyses were used to assess the beneficial effect of ALSS on HBV-derived HRS. In addition, a stratified analysis was carried out according to the degree of acute kidney injury (AKI) and the number of organ failures to observe in which populations ALSS can obtain the most excellent therapeutic effect. 669 patients were diagnosed as HRS, including 298 HBV negative and 371 HBV positive. Baseline characteristics were different between patients with HBV positive and HBV negative. HBV-derived HRS has higher 28-day mortality, though without a statistical difference. After PSM, 50 patients treated with ALSS and 150 patients treated with standard medical treatment (SMT) constituted a new cohort for the following analysis. We found that ALSS could significantly benefit HRS patients ( P = 0.025 ). Moreover, the median survival time of patients treated with ALSS was longer than those treated with SMT. INR, neutrophil percentage, and treatment with ALSS were independent predictive factors for short-term mortality in HBV-derived HRS. The stratified analysis showed that ALSS could reduce the 28-day mortality of patients with HBV-derived HRS, especially those in AKI stage 3 and with organ failure ≥ 2 . Additionally, serum bilirubin was significantly lower after ALSS, and the alteration of INR and creatinine were independent predictive elements for the mortality of HBV-derived HRS. HBV-derived HRS is more severe than non-HBV-derived HRS and has a worse prognosis. ALSS could reduce the short-term mortality of patients with HBV-derived HRS, especially those in AKI stage 3 and with organ failure ≥ 2 . INR and the change of creatinine and INR could predict the prognosis of HBV-derived HRS. ChiCTR2200060123.

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Section: Discussionmentioning

confidence: 99%

The Effect of Artificial Liver Support System on Prognosis of HBV-Derived Hepatorenal Syndrome: A Retrospective Cohort Study

Sheng

Zhou

et al. 2022

Disease Markers

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“…The mechanism of ALSS is based on the strong regenerative ability of liver cells through mechanical, physical, chemical, and biological equipment in vitro , removing all types of harmful substances, supplying necessary materials, improving the internal environment, temporarily replacing the partial failure of liver function, creating a good condition for liver cell regeneration and liver function recovery, or waiting for an opportunity for liver transplantation[ 15 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

Establishment of a risk assessment score for deep vein thrombosis after artificial liver support system treatment

Yun¹,

Li²,

Zhu³

et al. 2021

WJCC

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BACKGROUND The artificial liver support system (ALSS) is an effective treatment method for liver failure, but it requires deep venous intubation and long-term indwelling catheterization. However, the coagulation mechanism disorder of basic liver failure diseases, and deep venous thrombosis (DVT) often occur. AIM To evaluate the risk factors for DVT following use of an ALSS and establish a risk assessment score. METHODS This study was divided into three stages. In the first stage, the risk factors for DVT were screened and the patient data were collected, including ALSS treatment information; biochemical indices; coagulation and hematology indices; complications; procoagulant use therapy status; and a total of 24 indicators. In the second stage, a risk assessment score for DVT after ALSS treatment was developed. In the third stage, the DVT risk assessment score was validated. RESULTS A total of 232 patients with liver failure treated with ALSS were enrolled in the first stage, including 12 with lower limb DVT. Logistic regression analysis showed that age [odds ratio (OR), 1.734; P = 0.01], successful catheterization time (OR, 1.667; P = 0.005), activity status (strict bed rest) (OR, 3.049; P = 0.005), and D-dimer level (≥ 500 ng/mL) (OR, 5.532; P < 0.001) were independent risk factors for DVT. We then established a scoring system for risk factors. In the validation group, a total of 213 patients with liver failure were treated with ALSS, including 14 with lower limb DVT. When the cutoff value of risk assessment was 3, the specificity and sensitivity of the risk assessment score were 88.9% and 85.7%, respectively. CONCLUSION A simple risk assessment scoring system was established for DVT patients with liver failure treated with ALSS and was verified to have good sensitivity and specificity.

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“…Moreover, efforts in aggressive support care aimed at “downstaging” the severity score for ACLF can enhance posttransplant survival [ 18 ]. Plasma exchange has been shown to reverse organ failure and ameliorate the development of new organ failures and complications in patients with HBV-related ACLF [ 19 , 20 ]. Worsened INR or AARC score at day 14 after admission in our study suggests proceeding to fast-track liver transplant, or to plasmapheresis.…”

Section: Discussionmentioning

confidence: 99%

Dynamic Prognostication in Transplant Candidates with Acute-on-Chronic Liver Failure

Chen

et al. 2020

JPM

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We aimed to extensively investigate clinical markers that are sufficiently dynamic for prognosis of acute-on-chronic liver failure (ACLF). Defined by the Asian Pacific Association for the Study of the Liver (APASL) criteria, patients with ACLF on the liver transplant waitlist in a tertiary center were retrospectively reviewed. Laboratory results and severity scores at three time points (days 1, 7, and 14 after admission) were analyzed. From 2015 to 2019, 64 patients with ACLF were enrolled, of which 24 received a liver transplant from 22 live donors. The hospital mortality rate was 31% (8% for transplant; 45% for nontransplant groups), and the 3-month survival was crucial for determining long-term outcomes. The number of significant variables for mortality, and, specifically, the hazards of international normalized ratio of prothrombin time (INR) and APASL ACLF Research Consortium (AARC) score were increased within two weeks. In multivariable analysis, INR and AARC score (D-14) were associated with poor survival and liver transplant was a protective factor in all patients, while AARC score (D-14) was significant in the nontransplant group. AARC score at day 14 is an independent risk factor for mortality in ACLF. Liver transplant from live donors reversed poor outcomes in patients with ACLF in a timely manner.

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Effect of artificial liver support system on short‐term prognosis of patients with hepatitis B virus‐related acute‐on‐chronic liver failure

Cited by 16 publications

References 48 publications

The Effect of Artificial Liver Support System on Prognosis of HBV-Derived Hepatorenal Syndrome: A Retrospective Cohort Study

The Effect of Artificial Liver Support System on Prognosis of HBV-Derived Hepatorenal Syndrome: A Retrospective Cohort Study

Establishment of a risk assessment score for deep vein thrombosis after artificial liver support system treatment

Dynamic Prognostication in Transplant Candidates with Acute-on-Chronic Liver Failure

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