Therapeutic plasma exchange versus double plasma molecular absorption system in hepatitis B virus‐infected acute‐on‐chronic liver failure treated by entercavir: A prospective study

Wan, Yue-Meng; Li, Yuhua; Xu, Zhi‐Yuan; Yang, Jing; Yang, Lihong; Xu, Ying; Yang, Jinhui

doi:10.1002/jca.21535

Cited by 49 publications

(46 citation statements)

References 35 publications

(67 reference statements)

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“…Appropriate statistical methods are also important for assessing the effects of ALSS treatment in patients with HBV‐ACLF. A few single‐center studies with limited samples have reported the beneficial effect of ALSS on survival in patients with HBV‐ACLF 14,15,25 . In the present multicenter and large cohort study, we used multiple adjusted methods, including multivariable risk adjustment, case‐control matching, PSM, and IPTW analysis, to reduce the bias 29 .…”

Section: Discussionmentioning

confidence: 99%

Artificial liver treatment improves survival in patients with hepatitis B virus‐related acute‐on‐chronic liver failure: A case‐control matched analysis

Yang¹,

Jiang³

et al. 2020

Hepatology Research

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Aim The artificial liver support system (ALSS) is recognized as a bridge to liver transplantation in hepatitis B virus‐related acute‐on‐chronic liver failure (HBV‐ACLF) patients. However, patient survival remains unknown. We aim to assess the effects of ALSS on survival in HBV‐ACLF patients. Methods The clinical data of HBV‐ACLF patients receiving standard medical treatment (SMT) plus ALSS (ALSS group, n = 507) or only SMT (SMT group, n = 417) were collected for survival assessment. The main end‐points were cumulative survival rates at days 21, 28, and 90. Four different rigorous analyses were carried out to reduce bias and confounding. Results In the entire cohort, the cumulative survival rates at days 21, 28, and 90 were significantly higher in patients who underwent ALSS treatment (73.3% vs. 59.6%, 69.2% vs. 56.6%, 56.5% vs. 49.1%, respectively, P < 0.01) than in those who underwent SMT only. In the 276‐pair case–control matched cohort, a significantly higher survival rate was also observed in the ALSS group than in the SMT group on days 21, 28, and 90 (72.5% vs. 60.3%, 68.3% vs. 57.4%, 55.9% vs. 48.5%, respectively, P < 0.05), especially in patients with ACLF‐1 and ‐2. By a multivariable‐adjusted analysis, ALSS treatment was associated with a significantly lower risk of mortality, especially for ACLF‐2 at days 21, 28, and 90. These findings were also confirmed through propensity score matching and inverse probability treatment weighting analysis. Conclusions ALSS treatment can improve short‐term survival and is associated with a significantly lower risk of short‐term mortality in patients with HBV‐ACLF, especially ACLF‐2.

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Section: Discussionmentioning

confidence: 99%

Artificial liver treatment improves survival in patients with hepatitis B virus‐related acute‐on‐chronic liver failure: A case‐control matched analysis

Yang¹,

Jiang³

et al. 2020

Hepatology Research

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“…All patients took daily entecavir (0.5 mg/day) or tenofovir (300 mg/day) once they were tested positive for HBV-DNA throughout the study period. Most patients also underwent artificial liver support (ALS) treatment by therapeutic plasma exchange (TPE) and/or double plasma molecular absorption system (DPMAS) as described in previous studies 20 , 21 . During the hospitalization period, all patients received standard medical treatment, including intravenous reduced glutathione, polyene phosphatidylcholine, glycyrrhizin, and ademetionine.…”

Section: Methodsmentioning

confidence: 99%

Genotype Matters in Patients with Acuteon-chronic Liver Failure Due to Reactivation of Chronic Hepatitis B

Wan¹,

Li²,

Wu³

et al. 2018

Clinical and Translational Gastroenterology

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BackgroundAcute-on-chronic liver failure (ACLF) can be caused by reactivation of chronic hepatitis B virus (HBV) infection (HBV-ACLF). It’s unclear whether HBV genotypes affect the clinical and therapeutical outcomes of patients with HBV-ACLF. This study was to investigate the short-term antiviral response and overall survival in HBV-ACLF patients treated by tenofovir or entecavir.MethodsSeventy-three consecutive patients with HBV-ACLF were stratified into genotype B group (n = 33) and C group (n = 40). They were prospectively followed-up.ResultsAt 2 weeks, the genotype B group had significantly lower HBV-DNA load (P = 0.005), greater HBV-DNA decline (P = 0.026), higher proportion of patients with HBV-DNA < 500 IU/ml (P = 0.007), improved Child-Turcotte-Pugh (CTP; P = 0.032) and model for end-stage liver disease (MELD; P = 0.039) scores compared to the genotype C group. At three months, survivors in both groups had undetectable HBV-DNA loads, comparable CTP (P = 0.850) and MELD (P = 0.861) scores; the genotype C group had markedly lower overall survival rate than the B group (P = 0.013). The genotype (hazard ratio [HR]: 2.138; 95% confidence interval [CI]: 1.034–4.143; P = 0.041), MELD score (HR:1.664, 95%CI: 1.077–2.571; P = 0.022) and HBV-DNA decline (HR: 0.225, 95% CI: 0.067–0.758; P = 0.016) at 2 weeks were significantly associated with mortality at 3 months. No severe adverse event was noted.ConclusionsGenotype B was associated with better short-term antiviral response and clinical outcome compared to genotype C in patients with HBV-ACLF.

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“…In ACLF, there are two single-center, non-controlled observational studies [137,138] and two randomized controlled trials evaluating the plasma-exchange either against the molecular adsorbent system (non-MARS) [139] or standard of care [140]. Results suggest its feasibility and a positive effect on the survival.…”

Section: Extracorporeal Devicesmentioning

confidence: 99%

Neurocritical Care Management of Hepatic Encephalopathy and Coma in Liver Failure

Kerbert

Engelmann

Jalan

2018

Semin Respir Crit Care Med

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Hepatic encephalopathy (HE) is a severe complication of liver disease, describing a spectrum of neurological and psychiatric abnormalities ranging from subclinical alterations to coma. HE is the leading cause for hospital readmission, intensive care treatment, and mortality in patients with chronic liver disease. The complex and multifaceted pathogenesis is not yet fully understood, but hypotheses focus on ammonia and systemic inflammation, which are the main targets for currently available therapies in clinical practice. Nevertheless, the remaining high clinical relevance and healthcare burden of this syndrome underlines the emergence for further unraveling the full spectrum of pathomechanisms, as this provides the basis for the development of novel, highly targeted therapies. In this review, the most recent literature about current and future therapies for HE, relevant for intensive care management, will be discussed.

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Therapeutic plasma exchange versus double plasma molecular absorption system in hepatitis B virus‐infected acute‐on‐chronic liver failure treated by entercavir: A prospective study

Abstract: Compared to DPMAS, TPE was more efficient in eliminating TBIL, DBIL, and hsCRP, but it was associated with higher loss rate of albumin. TPE and DPMAS were similar in improving 12-week survivals in HBV-ACLF.

Cited by 49 publications

References 35 publications

Artificial liver treatment improves survival in patients with hepatitis B virus‐related acute‐on‐chronic liver failure: A case‐control matched analysis

Artificial liver treatment improves survival in patients with hepatitis B virus‐related acute‐on‐chronic liver failure: A case‐control matched analysis

Genotype Matters in Patients with Acuteon-chronic Liver Failure Due to Reactivation of Chronic Hepatitis B

Neurocritical Care Management of Hepatic Encephalopathy and Coma in Liver Failure

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