Plasma exchange-centered artificial liver support system of hepatitis B virus-related acute-on-chronic liver failure: a nationwide prospective multicenter study in China

被引:55
作者
Chen, Jia-Jia [1 ,2 ]
Huang, Jian-Rong [1 ,2 ]
Yang, Qian [1 ,2 ]
Xu, Xiao-Wei [1 ,2 ]
Liu, Xiao-Li [1 ,2 ]
Hao, Shao-Rui [1 ,2 ]
Wang, Hui-Fen [3 ]
Han, Tao [4 ]
Zhang, Jing [5 ]
Gan, Jian-He [6 ]
Gao, Zhi-Liang [7 ]
Wang, Yu-Ming [8 ]
Lin, Shu-Mei [9 ]
Xie, Qing [10 ]
Pan, Chen [11 ]
Li, Lan-Juan [1 ,2 ]
机构
[1] Zhejiang Univ, Affiliated Hosp 1, Sch Med, State Key Lab Diag & Treatment Infect Dis, Hangzhou 310003, Peoples R China
[2] Zhejiang Univ, Affiliated Hosp 1, Sch Med, Collaborat Innovat Ctr Diag & Treatment Infect Di, Hangzhou 310003, Peoples R China
[3] 302 Hosp Peoples Liberat Army, Liver Failure Therapy & Res Ctr, Beijing 100039, Peoples R China
[4] Tianjin Med Univ, Cent Clin Coll 3, Dept Hepatol, Tianjin 300170, Peoples R China
[5] Capital Med Univ, Youan Hosp, Artificial Liver Ctr, Beijing 100069, Peoples R China
[6] Suzhou Univ, Affiliated Hosp 1, Dept Infect Dis, Suzhou 215006, Peoples R China
[7] Sun Yat Sen Univ, Affiliated Hosp 3, Dept Infect Dis, Guangzhou 510630, Guangdong, Peoples R China
[8] Third Mil Med Univ, Southwest Hosp, Inst Infect Dis, Chongqing 400038, Peoples R China
[9] Xi An Jiao Tong Univ, Affiliated Hosp 1, Dept Infect Dis, Xian 710061, Peoples R China
[10] Shanghai Jiao Tong Univ, Ruijin Hosp, Sch Med, Dept Infect Dis, Shanghai 200025, Peoples R China
[11] Fujian Med Univ, Infect Dis Hosp, Dept Infect Dis, Fuzhou 350025, Peoples R China
关键词
liver failure; artificial liver support; plasma exchange; acute-on-chronic liver failure; BOUND SUBSTANCES; SCORING SYSTEM; TRANSPLANTATION; PROGNOSIS; PREDICTION;
D O I
10.1016/S1499-3872(16)60084-X
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
BACKGROUND: Plasma exchange (PE)-centered artificial liver support system reduced the high mortality rate of hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF). But the data were diverse in different medical centers. The present prospective nationwide study was to evaluate the effects of PE on patients with HBV-ACLF at different stages. METHODS: From December 2009 to December 2011, we evaluated 250 patients at different stages of HBV-ACLF from 10 major medical centers in China. All the laboratory parameters were collected at admission, before and after PE. RESULTS: Among the 250 patients who underwent 661 rounds of PE, one-month survival rate was 61.6%; 141 (56.4%) showed improvement after PE. Variables such as age (P=0.000), levels of total bilirubin (TB, P=0.000), direct bilirubin (P=0.000), total triglycerides (P=0.000), low-density lipoprotein (P=0.022), Na+ (P=0.014), Cl- (P=0.038), creatinine (Cr, P=0.007), fibrinogen (P=0.000), prothrombin time (PT, P=0.000), white blood cell (P=0.000), platelet (P=0.003) and MELD (P=0.000) were significantly related to prognosis. Multivariate logistic regression analysis showed that age, disease stage, TB, Cr and PT levels were independent risk factors of mortality among HBV-ACLF patients. CONCLUSIONS: PE can improve the clinical outcome of patients with HBV-ACLF. Levels of TB, Cr and PT, age and disease stage help to predict prognosis.
引用
收藏
页码:275 / 281
页数:7
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