Three Artificial Liver Models of Treatment of Acute-on-Chronic Liver Failure.

Background: This study aimed to investigate clinical efficacy, safety and short-term prognosis of plasma exchange (PE), plasma perfusion combining PE (PP+PE), dual-plasma molecular adsorption system combining PE (DPMAS+PE) in treating acute-on-chronic liver failure (ACLF).

Methods: Two hundred and fourteen ACLF patients admitted to our hospital were included and divided into PE (n = 72), PP+PE (n = 75), DPMAS+PE group (n = 67). Laboratory indexes and MELD scores were collected, and clinical efficacy was compared. Patients' adverse reactions during and 24-h after treatment were collected, and safety was compared. Survival status of patients was followed-up within 90 days, and prognosis was analyzed.

Results: PE, PP+PE and DPMAS+PE significantly reduce TBiL, DBiL, ALT, AST, SA, PT, INR, PCT and CRP levels, and increase PA and PTA levels, compared with pre-treatments (P < 0.05). WBC and SCR levels in DPMAS+PE group decreased significantly post-treatment (P < 0.05). Na⁺ and Cl^- levels in PE and PP+PE group decreased significantly post-treatment (P < 0.05). Total adverse reaction incidence in PE, PP+PE, DPMAS+PE group were 38.89%, 22.70%, 17.90%, respectively, with significant differences among three groups (P < 0.05). Ninety-day mortality rates of patients in PE, PP+PE, DPMAS+PE group were 41.67%, 34.67%, 20.90%, respectively, with significant differences among three groups (P < 0.05).

Conclusion: PE, PP+PE and DPMAS+PE three artificial liver treatment modes can effectively improve liver, kidney and coagulation function of ACLF patients. DPMAS+PE demonstrated better ability to remove endotoxin and inflammatory mediators, showed advantages in reducing ACLF patient mortality within 90 days, and had the least impact on electrolyte post-treatment. Therefore, DPMAS+PE can be used as a better choice for clinical treatment.