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

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

doi:10.3389/fmed.2021.779744

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

Front Med (Lausanne). 2021 Nov 16:8:779744. doi: 10.3389/fmed.2021.779744. eCollection 2021.

Authors

Yuan-Yuan Chen¹, Hai Li², Bao-Yan Xu³, Xin Zheng⁴, Bei-Ling Li⁵, Xian-Bo Wang⁶, Yan Huang⁷, Yan-Hang Gao⁸, Zhi-Ping Qian⁹, Feng Liu¹⁰, Xiao-Bo Lu¹¹, Jia Shang¹², Hai Li¹³, Shao-Yang Wang¹⁴, Yin-Hua Zhang¹, Zhong-Ji Meng¹; Chinese Chronic Liver Failure (CLIF) Consortium

Collaborators

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

Affiliations

¹ Department of Infectious Diseases, Hubei Clinical Research Center for Precise Diagnosis and Therapy of Liver Cancer, Taihe Hospital, Hubei University of Medicine, Shiyan, China.
² Key Laboratory of Gastroenterology and Hepatology, Department of Gastroenterology, Renji Hospital, School of Medicine, Shanghai Institute of Digestive Disease, Shanghai Jiao Tong University, Chinese Ministry of Health (Shanghai Jiao Tong University), Shanghai, China.
³ Department of Infectious Diseases, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.
⁴ Department of Infectious Diseases, Institute of Infection and Immunology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
⁵ Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China.
⁶ Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China.
⁷ Hunan Key Laboratory of Viral Hepatitis, Department of Infectious Disease, Xiangya Hospital, Central South University, Changsha, China.
⁸ Department of Hepatology, The First Hospital of Jilin University, Changchun, China.
⁹ Department of Liver Intensive Care Unit, Shanghai Public Health Clinical Centre, Fudan University, Shanghai, China.
¹⁰ Department of Infectious Diseases and Hepatology, The Second Hospital of Shandong University, Jinan, China.
¹¹ Liver Disease Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
¹² Department of Infectious Diseases, Henan Provincial People's Hospital, Zhengzhou, China.
¹³ Infectious Disease Center, Affiliated Hospital of Logistics University of People's Armed Police Force, Tianjin, China.
¹⁴ Department of Infectious Diseases, Fuzhou General Hospital of Nanjing Military Command, Fuzhou, China.

Abstract

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.

Keywords: acute-on-chronic liver failure; hepatitis B virus; plasma exchange; propensity score matching; survival rate.