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

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.