[Analysis of the efficacy and survival outcomes of plasma exchange combined with dual plasma molecular adsorption system therapy in liver failure].

Abstract

Objective: To investigate the therapeutic effect and prognostic impact of plasma exchange (PE) combined with dual plasma molecular adsorption system (DPMAS) therapy in patients with liver failure (LF). Methods: A retrospective study was conducted. Data from patients with LF admitted to the Department of Infectious Diseases, Anhui Provincial Hospital, from April 2018 to July 2024 were included. Patients were divided into a PE group and a PE+DPMAS group according to the treatment modality. Propensity score matching was used to reduce baseline differences. Changes in laboratory parameters before and after treatment were analyzed to compare the efficacy of the two treatment strategies. Short-term prognostic factors associated with survival were analyzed. The differences between groups were compared using the χ² test for count data. Normally distributed continuous variables were compared between groups using an independent samples t-test. Continuous variables with skewed distributions were compared between groups using the Mann-Whitney U test . Cutoff values were determined using receiver operating characteristic curve analysis. Covariates, including age, sex, etiology, type, stage, and Model for End-Stage Liver Disease score, were included in the propensity score matching. Nearest-neighbor matching was employed for 1∶1 matching of unmatched patients between the two groups (caliper value of 0.05). Survival analysis was performed using the Kaplan-Meier method. The log-rank test was used to analyze survival differences between groups. Univariate and multivariate Cox proportional survival analyses were used to explore risk factors affecting survival and to calculate hazard ratios with 95% confidence intervals. Results: A total of 256 patients with LF were included. Among them, 100 patients were in the PE group and 156 patients were in the PE+DPMAS group. 76 patients were matched in each group following propensity score matching. The results showed that the PE+DPMAS group, in terms of bilirubin clearance, improvement in coagulation function, and a reduction in the Model for End-Stage Liver Disease score, had significantly superior results to the PE group (P<0.001). Survival analysis showed a significantly higher 8-week survival rate in the combined treatment group (81.28% vs. 56.18%, Log-rank, P=0.011). Subgroup analyses according to etiology and subtype further revealed greater survival benefits among patients with hepatitis B-related LF, drug-induced LF, and chronic-onset LF treated with PE+DPMAS. Multivariate COX regression analysis confirmed that total bilirubin ≥300 μmol/L and combined DPMAS+PE therapy were independent prognostic factors. There was no statistically significant difference in the incidence of treatment-related adverse events between the two groups (P>0.05). Conclusion: The combination of PE and DPMAS significantly improves bilirubin clearance efficiency, enhances coagulation function, reduces Model for End-Stage Liver Disease scores, and effectively improves short-term survival rates in patients with LF.