Plasma Exchange-Based Non-bioartificial Liver Support System Improves the Short-Term Outcomes of Patients With Hepatitis B Virus-Associated Acute-on-Chronic Liver Failure: A Multicenter Prospective Cohort Study

Background and aims: Hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF) is a complicated syndrome with extremely high short-term mortality. Whether plasma exchange (PE) improves HBV-ACLF outcomes remains controversial. Here, PE-based non-bioartificial liver support system (NB-ALS...

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Autores principales:	Yuan-yuan Chen, Hai Li, Bao-yan Xu, Xin Zheng, Bei-ling Li, Xian-bo Wang, Yan Huang, Yan-hang Gao, Zhi-ping Qian, Feng Liu, Xiao-bo Lu, Jia Shang, Shao-yang Wang, Yin-hua Zhang, Zhong-ji Meng, Chinese Chronic Liver Failure (CLIF) Consortium, Shan Yin, Wenyi Gu, Yan Zhang, Tongyu Wang, Dandan Wu, Fuchen Dong, Bo Zeng, Liuying Chen, Shijin Wang, Qun Zhang, Yixin Hou, Yuxin Li, Yunyi Huang, Shuning Sun, Wenting Tan, Xiaomei Xiang, Yunjie Dan, Guohong Deng, Jun Chen, Chengjin Liao, Xiaoxiao Liu, Jing Liu, Ling Xu, Shue Xiong, Yan Xiong, Congcong Zou, Jinjun Chen, Congyan Zhu, Chang Jiang, Xiaoyu Wen, Na Gao, Chunyan Liu, Qing Lei, Sen Luo, Haotang Ren, Xue Mei, Jiefei Wang, Liujuan Ji, Tao Li, Xuanqiong Fang, Jing Li, Ziyu Wan, Rongjiong Zheng, Fangrong Jie, Nan Li, Huiming Jin, Qing Zhang, Xuequn Zheng, Shaoyang Wang, Taofa Lin
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	acute-on-chronic liver failure hepatitis B virus plasma exchange survival rate propensity score matching Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/fe645848ddf2431890f05bcc44194866
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spelling	oai:doaj.org-article:fe645848ddf2431890f05bcc441948662021-11-16T07:19:02ZPlasma Exchange-Based Non-bioartificial Liver Support System Improves the Short-Term Outcomes of Patients With Hepatitis B Virus-Associated Acute-on-Chronic Liver Failure: A Multicenter Prospective Cohort Study2296-858X10.3389/fmed.2021.779744https://doaj.org/article/fe645848ddf2431890f05bcc441948662021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fmed.2021.779744/fullhttps://doaj.org/toc/2296-858XBackground and aims: Hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF) is a complicated syndrome with extremely high short-term mortality. Whether plasma exchange (PE) improves HBV-ACLF outcomes remains controversial. Here, PE-based non-bioartificial liver support system (NB-ALSS) effects on short-term HBV-ACLF patient outcomes were investigated.Materials and methods: HBV-ACLF patients from Chinese Acute-on-chronic Liver Failure (CATCH-LIFE) cohort receiving standard medical therapy (SMT) alone or PE-based NB-ALSS in addition to SMT were allocated to SMT and SMT+PE groups, respectively; propensity score matching (PSM) was used to eliminate confounding bias. Short-term (28/90-day and 1-year) survival rates were calculated (Kaplan-Meier).Results: In total, 524 patients with HBV-ACLF were enrolled in this study; 358 received SMT alone (SMT group), and the remaining 166 received PE-based NB-ALSS in addition to SMT (SMT+PE group). PSM generated 166 pairs of cases. In the SMT+PE group, 28-day, 90-day, and 1-year survival rates were 11.90, 8.00, and 10.90%, respectively, higher than those in the SMT group. Subgroup analysis revealed that PE-based NB-ALSS had the best efficacy in patients with ACLF grade 2 or MELD scores of 30–40 (MELD grade 3). In MELD grade 3 patients who received SMT+PE, 28-day, 90-day, and 1-year survival rates were improved by 18.60, 14.20, and 20.10%, respectively. According to multivariate Cox regression analysis, PE-based NB-ALSS was the only independent protective factor for HBV-ACLF patient prognosis at 28 days, 90 days, and 1 year (28 days, HR = 0.516, p = 0.001; 90 days, HR = 0.663, p = 0.010; 1 year, HR = 0.610, p = 0.051). For those who received SMT+PE therapy, PE-based NB-ALSS therapy frequency was the only independent protective factor for short-term prognosis (28-day, HR = 0.597, p = 0.001; 90-day, HR = 0.772, p = 0.018).Conclusions: This multicenter prospective study showed that the addition of PE-based NB-ALSS to SMT improves short-term (28/90 days and 1-year) outcomes in patients with HBV-ACLF, especially in MELD grade 3 patients. Optimization of PE-based NB-ALSS may improve prognosis or even save lives among HBV-ACLF patients.Yuan-yuan ChenHai LiBao-yan XuXin ZhengBei-ling LiXian-bo WangYan HuangYan-hang GaoZhi-ping QianFeng LiuXiao-bo LuJia ShangHai LiShao-yang WangYin-hua ZhangZhong-ji MengChinese Chronic Liver Failure (CLIF) ConsortiumShan YinWenyi GuYan ZhangTongyu WangDandan WuFuchen DongBo ZengLiuying ChenShijin WangQun ZhangYixin HouYuxin LiYunyi HuangShuning SunWenting TanXiaomei XiangYunjie DanGuohong DengJun ChenChengjin LiaoXiaoxiao LiuJing LiuLing XuShue XiongYan XiongCongcong ZouJinjun ChenCongyan ZhuChang JiangXiaoyu WenNa GaoChunyan LiuQing LeiSen LuoHaotang RenXue MeiJiefei WangLiujuan JiTao LiXuanqiong FangJing LiZiyu WanRongjiong ZhengFangrong JieNan LiHuiming JinHai Li Qing ZhangXuequn ZhengShaoyang WangTaofa LinFrontiers Media S.A.articleacute-on-chronic liver failurehepatitis B virusplasma exchangesurvival ratepropensity score matchingMedicine (General)R5-920ENFrontiers in Medicine, Vol 8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	acute-on-chronic liver failure hepatitis B virus plasma exchange survival rate propensity score matching Medicine (General) R5-920
spellingShingle	acute-on-chronic liver failure hepatitis B virus plasma exchange survival rate propensity score matching Medicine (General) R5-920 Yuan-yuan Chen Hai Li Bao-yan Xu Xin Zheng Bei-ling Li Xian-bo Wang Yan Huang Yan-hang Gao Zhi-ping Qian Feng Liu Xiao-bo Lu Jia Shang Hai Li Shao-yang Wang Yin-hua Zhang Zhong-ji Meng Chinese Chronic Liver Failure (CLIF) Consortium Shan Yin Wenyi Gu Yan Zhang Tongyu Wang Dandan Wu Fuchen Dong Bo Zeng Liuying Chen Shijin Wang Qun Zhang Yixin Hou Yuxin Li Yunyi Huang Shuning Sun Wenting Tan Xiaomei Xiang Yunjie Dan Guohong Deng Jun Chen Chengjin Liao Xiaoxiao Liu Jing Liu Ling Xu Shue Xiong Yan Xiong Congcong Zou Jinjun Chen Congyan Zhu Chang Jiang Xiaoyu Wen Na Gao Chunyan Liu Qing Lei Sen Luo Haotang Ren Xue Mei Jiefei Wang Liujuan Ji Tao Li Xuanqiong Fang Jing Li Ziyu Wan Rongjiong Zheng Fangrong Jie Nan Li Huiming Jin Hai Li Qing Zhang Xuequn Zheng Shaoyang Wang Taofa Lin Plasma Exchange-Based Non-bioartificial Liver Support System Improves the Short-Term Outcomes of Patients With Hepatitis B Virus-Associated Acute-on-Chronic Liver Failure: A Multicenter Prospective Cohort Study
description	Background and aims: Hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF) is a complicated syndrome with extremely high short-term mortality. Whether plasma exchange (PE) improves HBV-ACLF outcomes remains controversial. Here, PE-based non-bioartificial liver support system (NB-ALSS) effects on short-term HBV-ACLF patient outcomes were investigated.Materials and methods: HBV-ACLF patients from Chinese Acute-on-chronic Liver Failure (CATCH-LIFE) cohort receiving standard medical therapy (SMT) alone or PE-based NB-ALSS in addition to SMT were allocated to SMT and SMT+PE groups, respectively; propensity score matching (PSM) was used to eliminate confounding bias. Short-term (28/90-day and 1-year) survival rates were calculated (Kaplan-Meier).Results: In total, 524 patients with HBV-ACLF were enrolled in this study; 358 received SMT alone (SMT group), and the remaining 166 received PE-based NB-ALSS in addition to SMT (SMT+PE group). PSM generated 166 pairs of cases. In the SMT+PE group, 28-day, 90-day, and 1-year survival rates were 11.90, 8.00, and 10.90%, respectively, higher than those in the SMT group. Subgroup analysis revealed that PE-based NB-ALSS had the best efficacy in patients with ACLF grade 2 or MELD scores of 30–40 (MELD grade 3). In MELD grade 3 patients who received SMT+PE, 28-day, 90-day, and 1-year survival rates were improved by 18.60, 14.20, and 20.10%, respectively. According to multivariate Cox regression analysis, PE-based NB-ALSS was the only independent protective factor for HBV-ACLF patient prognosis at 28 days, 90 days, and 1 year (28 days, HR = 0.516, p = 0.001; 90 days, HR = 0.663, p = 0.010; 1 year, HR = 0.610, p = 0.051). For those who received SMT+PE therapy, PE-based NB-ALSS therapy frequency was the only independent protective factor for short-term prognosis (28-day, HR = 0.597, p = 0.001; 90-day, HR = 0.772, p = 0.018).Conclusions: This multicenter prospective study showed that the addition of PE-based NB-ALSS to SMT improves short-term (28/90 days and 1-year) outcomes in patients with HBV-ACLF, especially in MELD grade 3 patients. Optimization of PE-based NB-ALSS may improve prognosis or even save lives among HBV-ACLF patients.
format	article
author	Yuan-yuan Chen Hai Li Bao-yan Xu Xin Zheng Bei-ling Li Xian-bo Wang Yan Huang Yan-hang Gao Zhi-ping Qian Feng Liu Xiao-bo Lu Jia Shang Hai Li Shao-yang Wang Yin-hua Zhang Zhong-ji Meng Chinese Chronic Liver Failure (CLIF) Consortium Shan Yin Wenyi Gu Yan Zhang Tongyu Wang Dandan Wu Fuchen Dong Bo Zeng Liuying Chen Shijin Wang Qun Zhang Yixin Hou Yuxin Li Yunyi Huang Shuning Sun Wenting Tan Xiaomei Xiang Yunjie Dan Guohong Deng Jun Chen Chengjin Liao Xiaoxiao Liu Jing Liu Ling Xu Shue Xiong Yan Xiong Congcong Zou Jinjun Chen Congyan Zhu Chang Jiang Xiaoyu Wen Na Gao Chunyan Liu Qing Lei Sen Luo Haotang Ren Xue Mei Jiefei Wang Liujuan Ji Tao Li Xuanqiong Fang Jing Li Ziyu Wan Rongjiong Zheng Fangrong Jie Nan Li Huiming Jin Hai Li Qing Zhang Xuequn Zheng Shaoyang Wang Taofa Lin
author_facet	Yuan-yuan Chen Hai Li Bao-yan Xu Xin Zheng Bei-ling Li Xian-bo Wang Yan Huang Yan-hang Gao Zhi-ping Qian Feng Liu Xiao-bo Lu Jia Shang Hai Li Shao-yang Wang Yin-hua Zhang Zhong-ji Meng Chinese Chronic Liver Failure (CLIF) Consortium Shan Yin Wenyi Gu Yan Zhang Tongyu Wang Dandan Wu Fuchen Dong Bo Zeng Liuying Chen Shijin Wang Qun Zhang Yixin Hou Yuxin Li Yunyi Huang Shuning Sun Wenting Tan Xiaomei Xiang Yunjie Dan Guohong Deng Jun Chen Chengjin Liao Xiaoxiao Liu Jing Liu Ling Xu Shue Xiong Yan Xiong Congcong Zou Jinjun Chen Congyan Zhu Chang Jiang Xiaoyu Wen Na Gao Chunyan Liu Qing Lei Sen Luo Haotang Ren Xue Mei Jiefei Wang Liujuan Ji Tao Li Xuanqiong Fang Jing Li Ziyu Wan Rongjiong Zheng Fangrong Jie Nan Li Huiming Jin Hai Li Qing Zhang Xuequn Zheng Shaoyang Wang Taofa Lin
author_sort	Yuan-yuan Chen
title	Plasma Exchange-Based Non-bioartificial Liver Support System Improves the Short-Term Outcomes of Patients With Hepatitis B Virus-Associated Acute-on-Chronic Liver Failure: A Multicenter Prospective Cohort Study
title_short	Plasma Exchange-Based Non-bioartificial Liver Support System Improves the Short-Term Outcomes of Patients With Hepatitis B Virus-Associated Acute-on-Chronic Liver Failure: A Multicenter Prospective Cohort Study
title_full	Plasma Exchange-Based Non-bioartificial Liver Support System Improves the Short-Term Outcomes of Patients With Hepatitis B Virus-Associated Acute-on-Chronic Liver Failure: A Multicenter Prospective Cohort Study
title_fullStr	Plasma Exchange-Based Non-bioartificial Liver Support System Improves the Short-Term Outcomes of Patients With Hepatitis B Virus-Associated Acute-on-Chronic Liver Failure: A Multicenter Prospective Cohort Study
title_full_unstemmed	Plasma Exchange-Based Non-bioartificial Liver Support System Improves the Short-Term Outcomes of Patients With Hepatitis B Virus-Associated Acute-on-Chronic Liver Failure: A Multicenter Prospective Cohort Study
title_sort	plasma exchange-based non-bioartificial liver support system improves the short-term outcomes of patients with hepatitis b virus-associated acute-on-chronic liver failure: a multicenter prospective cohort study
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/fe645848ddf2431890f05bcc44194866
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Plasma Exchange-Based Non-bioartificial Liver Support System Improves the Short-Term Outcomes of Patients With Hepatitis B Virus-Associated Acute-on-Chronic Liver Failure: A Multicenter Prospective Cohort Study

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