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.

BackgroundTherapeutic plasma exchange (TPE) and double plasma molecular absorption system (DPMAS) were two extracorporeal liver support systems. Few studies compared their efficacy profile. ObjectiveThis study was to compare the efficacy of TPE and DPMAS on acute-on-chronic liver failure (ACLF) caused by hepatitis B virus (HBV-ACLF). Methods60 HBV-ACLF patients were enrolled and prospectively studied. All patients received entecavir therapy, and were assigned to TPE group (n=33) and DPMAS group (n=27). Primary end-points were the effects of TPE and DPMAS on liver function and serum inflammatory markers. ResultsSerum procalcitonin, interleukin (IL)-6, and high sensitive C-reactive protein (hsCRP) were significantly elevated in patients with HBV-ACLF. TPE achieved significantly higher removal rates of total bilirubin (TBIL, P=.002), direct bilirubin (DBIL, P=.006), and hsCRP (P=.010) than DPMAS, but DPMAS displayed lower loss rate of albumin (P=.000). TPE and DPMAS resulted in similarly increased serum IL-6 levels and comparable 12-week survivals (P>.05). Multivariate analysis showed that hospital stay (Relative Risk [RR]: 1.062, 95% Confidence Interval [CI]: 1.011-1.115, P=.016), prothrombin time (RR: 1.346, 95% CI: 1.077-1.726, P=.010), and international normalized ratio (RR: 0.013, 95% CI: 0.006-0.788, P=.041) were independent predictors for 12-week survival. Both TPE and DPMAS treatments were well-tolerated. ConclusionCompared 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.