Objective To explore the relationship between the start time of plasma diafiltration (PDF) intervention with artificial liver and the in-hospital prognosis of the patients with hepatitis B-related acute chronic liver failure (HBV-ACLF). Methods The patients diagnosed with HBV-ACLF from January 1 2017 to December 31, 2021 were selected and divided into an improved group and a non-improved group according to their in-hospital prognosis. Univariate and multivariate logistic regression analyses were performed using their demographics, baseline laboratory examinations, and in-hospital prognosis of the two groups to obtain the independent influencing factors. Smooth curve fitting was used to explore the correlation between start time of PDF and in-hospital prognosis. Results A total of 88 patients were included, with 60 patients in the improved group (68.2%). Univariate logistic regression showed that start time of PDF intervention (OR=1.03,95% CI: 1.01~1.04,P＜0.001), age (OR=1.06, 95% CI:1.02~1.11,P=0.005), baseline blood alanine aminotransferase (OR=1.00, 95% CI:1.00~1.00, P=0.012), and baseline abdominal infection (OR=3.13, 95% CI: 1.20~8.14, P=0.019) were the possible influencing factors for in-hospital prognosis. Multivariate logistic regression showed that the start time of PDF intervention (OR=1.04,95% CI: 1.02~1.05,P＜0.001), age (OR=1.08,95% CI:1.01~1.14, P=0.038), and HBV-ACLF at an early stage (OR=0.13, 95% CI:0.02~0.98,P=0.048) were the independent influencing factors for adverse in-hospital prognosis. There may be a threshold effect between the start time of PDF intervention and adverse in-hospital prognosis. The segmented regression model showed that the optimal threshold was 72 hours, less than 72 hours with the OR=0.75 (95% CI: 0.53~1.05,P=0.089), and more than 72 hours with the OR=1.04(95% CI:1.02~1.06,P＜0.001). Conclusion There was a threshold effect between the start time of PDF intervention and the adverse in-hospital prognosis of the patients. Preoperative evaluation and initiation of PDF intervention within 72 hours after the diagnosis of HBV-ACLF may be one of the potential opportunities of clinical treatment.
[1] Moreau R, Jalan R, Gines P, et al.Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis[J][J].Gastroenterology, 2013, 144((7)):1426-1437-1431-1437
[2] Zaccherini G, Weiss E, Moreau R.Acute-on-chronic liver failure: Definitions, pathophysiology and principles of treatment[J][J].JHEP Rep, 2021, 3((1)):100176-100176
[3] Wang X, Sarin S K, Ning Q.Definition of ACLF and inclusion criteria for extra-hepatic organ failure[J][J].Hepatol Int, 2015, 9((3)):360-365
[4] Larsen F S.Artificial liver support in acute and acute-on-chronic liver failure[J][J].Curr Opin Crit Care, 2019, 25((2)):187-191
[5] Chen T, Yang Z, Choudhury A K, et al.Complications constitute a major risk factor for mortality in hepatitis B virus-related acute-on-chronic liver failure patients: a multi-national study from the Asia-Pacific region[J][J].Hepatol Int, 2019, 13((6)):695-705
[6] Tandon R, Froghi S.Artificial liver support systems[J][J].J Gastroenterol Hepatol, 2021, 36((5)):1164-1179
[7] 章益民，谢中阳，李兰娟.肝衰竭诊治进展与热点问题[J][J].中国临床医生杂志, 2020, 48((11)):1261-1265
[8] Jindal A, Sarin S K.Epidemiology of liver failure in Asia-Pacific region[J][J].Liver Int., 2022, 42((9)):2093-2109
[9] 刘月英，黄建荣.非生物型人工肝治疗的变迁与展望[J][J].中华肝脏病杂志, 2017, 25((09)):646-650
[10] 李爽，刘静，陈煜.非生物型人工肝在肝衰竭中的临床应用及进展[J][J].临床肝胆病杂志, 2019, 35((09)):1909-1915
[11] 刘磊，韩涛.非生物型人工肝在非肝衰竭疾病治疗中的应用进展[J][J].临床肝胆病杂志., 2020, 36((09)):2115-2118
[12] Yang L, Wu T, Li J, et al.Artificial liver treatment improves survival in patients with hepatitis B virus-related acute-on-chronic liver failure: A case-control matched analysis[J][J].Hepatol Res, 2020, 50((6)):656-670
[13] 陈珍，李自琼，黄文祥.肝衰竭血浆滤过透析应用进展[J][J].西部医学, 2015, 27((07)):1113-1115
[14]中华医学会感染病学分会肝衰竭与人工肝学组 中华医学会肝病学分会重型肝病与人工肝学组. 肝衰竭诊治指南(2018年版)[J][J].中华肝脏病杂志, 2019, 27((01)):18-26
[15] 白浪，陈煜，陈源文，等.人工肝血液净化技术临床应用专家共识(2022年版)[J][J].临床肝胆病杂志, 2022, 38((04)):767-775
[16] 中华医学会感染病学分会肝衰竭与人工肝学组.非生物型人工肝治疗肝衰竭指南(2016年版)[J][J].中华临床感染病杂志, 2016, 9((02)):97-103
[17]Patrick S K, Russell H W, Michael M, et al.A model to predict survival in patients with end-stage liver disease[J][J].Hepatology, 2001, 33((2)):464-70
[18] 王宇，郭利民，熊号峰，等.不同成分血浆滤过透析治疗重型肝炎患者56例[J][J].世界华人消化杂志, 2009, 17((23)):2433-2437
[19] 中华医学会肝脏病学分会重型肝病与人工肝学组中华医学会感染病学分会肝衰竭与人工肝学组.肝衰竭诊治指南(2018年版)[J][J].中华肝脏病杂志, 2019, 27((01)):18-26
[20] Arroyo V, Moreau R, Jalan R.Acute-on-Chronic Liver Failure[J][J].N Engl J Med, 2020, 382((22)):2137-2145
[21] Bajaj J S, O' Leary J G, Lai J C, et al.Acute-on-Chronic Liver Failure Clinical Guidelines[J][J].Am J Gastroenterol, 2022, 117((2)):225-252
[22] Arroyo V, Moreau R, Jalan R, et al.Acute-on-chronic liver failure: A new syndrome that will re-classify cirrhosis[J][J].J Hepatol, 2015, 62((1 Suppl)):S131-S143
[23] Kabbani A R, Tergast T L, Manns M P, et al.[Treatment strategies for acute-on-chronic liver failure][J][J].Med Klin Intensivmed Notfmed, 2021, 116((1)):3-16
[24] Mezzano G, Juanola A, Cardenas A, et al.Global burden of disease: acute-on-chronic liver failure, a systematic review and meta-analysis[J][J].Gut, 2022, 71((1)):148-155
[25] 杨荣利，周恒杰.人工肝技术的研究进展[J][J].华西医学, 2018, 33((7)):810-815
[26] 陈煜，李爽.人工肝支持系统的临床应用[J][J].临床荟萃, 2016, 31((07)):717-722.
[27] Li P, Liang X, Xu S, et al.A non-bioartificial liver support system combined with transplantation in HBV-related acute-on-chronic liver failure[J][J].Sci Rep, 2021, 11((1)):2975-2975
[28] Xiao L L, Xu X W, Huang K Z, et al.Corrigendum to " Artificial Liver Support System Improves Short-Term Outcomes of Patients with HBV-Associated Acute-on-Chronic Liver Failure: A Propensity Score Analysis" [J][J].Biomed Res Int, 2021, 2019(-):3757149-3757149
[29] 郭利民.肝衰竭人工肝治疗的个体化选择[J][J].中华临床感染病杂志, 2017, 10((02)):113-118
[30] 张斌，陈明迪，郜琨，等.组合血液净化对多脏器功能障碍合并肝衰竭患者疗效[J][J].中华急诊医学杂志, 2018, 27((09)):1010-1014
[31] 刘春涛，武瑞，俞海燕，等.血浆透析滤过对慢加急性肝衰竭患者血清细胞因子水平及预后的影响[J][J].中国现代医生, 2018, 56((29)):13-16
[32] 邹波，彭双福，朱啸峰.人工肝血浆滤过透析治疗重型肝炎的疗效观察及对血清AFP水平的影响[J][J].当代医学, 2019, 25((33)):68-70
[33] 冯钧帅，傅彩虹，马茹，等.血浆滤过透析治疗肝衰竭合并脓毒症的疗效[J][J].临床荟萃., 2019,, 34((4)):330-333
[34] 张宏涛，朱桂珍，阎磊，等.血浆透析滤过治疗全身炎症反应综合征诱发的急性肾损伤患者临床研究[J][J].中华实用诊断与治疗杂志, 2017, 31((10)):1009-1010
[35] 钱志平，陈楠，张宇一，等.血浆透析滤过治疗HBV相关慢加急性肝衰竭预后的影响因素分析[J][J].肝脏, 2017, 22((2)):111-115
[36] Nakae H, Eguchi Y, Yoshioka T, et al.Plasma diafiltration therapy in patients with postoperative liver failure[J][J].Ther Apher Dial, 2011, 15((4)):406-410
[37] 梅雪，陈楠，张宇一，等.连续性血浆透析滤过在肝衰竭患者中的应用[J][J].中国医师杂志, 2016, 18((03)):333-337
[38] 廖艳霞，何德宁，陈卫国.重型肝炎患者应用血浆透析滤过治疗对细胞因子水平和预后情况的影响[J][J].中国医学创新., 2020, 17((34)):1-5
[39] 刘天昭，罗燕.血浆滤过透析治疗慢加急性肝衰竭疗效观察[J][J].贵阳中医学院学报, 2018, 40((3)):52-54
[40] 崔嵩，晁娇娇，周恒杰，等.血浆透析滤过技术治疗肝功能衰竭疗效分析[J][J].医学理论与实践, 2019, 32((6)):788-790, 810
[41] Nakae H, Eguchi Y, Saotome T, et al.Multicenter study of plasma diafiltration in patients with acute liver failure[J][J].Ther Apher Dial, 2010, 14((5)):444-450
[42] Komura T, Taniguchi T, Sakai Y, et al.Efficacy of continuous plasma diafiltration therapy in critical patients with acute liver failure[J][J].J Gastroenterol Hepatol, 2014, 29((4)):782-786
[43] 杨仙珊，周莉，李璐，等.血浆透析滤过治疗时间对肝衰竭治疗效果的影响[J][J].临床肝胆病杂志, 2018, 34((5)):1052-1054
[44] 王春莲.重症急性胰腺炎血液净化模式和时机的选择[J][J].世界最新医学信息文摘, 2019,, 19((57)):143-148
[45] 陈思睿，赵双平，蔡茜.以KDIGO AKI分期作为脓毒症患者血液净化治疗时机的研究[J][J].中国医师杂志, 2016, 18((01)):66-69
[46] 王磊，陈保敏，刘莎莎.急性药物或毒物中毒中应用血液净化治疗的时机和方法分析[J][J].当代医学, 2019, 25((18)):15-17
[47] 贺杰，康霞艳，周雄，等.连续性肾脏替代治疗在儿童急性肾损伤的应用时机探讨[J][J].中国小儿急救医学, 2021, 28((11)):941-945
[48] 吴相伟，叶继辉，孙敏，等.CRRT启动时机与脓毒症相关性AKI患者预后的关系[J][J].中华危重病急救医学, 2020, 32((11)):1352-1355
[49] 邱晓华，邱海波.持续性肾脏替代治疗时机 剂量及模式选择[J][J].中国实用内科杂志, 2012, 32((06)):423-425
[50] 徐秋仙，张振纲，聂华，等.非生物型人工肝对乙型肝炎肝衰竭干预时机的临床研究[J][J].中西医结合肝病杂志, 2015, 25((03)):133-136,140
[51] Xiao L L, Wu X X, Chen J J, et al.Progress in hepatitis B virus-related acute-on-chronic liver failure treatment in China: A large, multicenter, retrospective cohort study using a propensity score matching analysis[J][J].Hepatobiliary Pancreat Dis Int, 2021, 20((6)):535-541
[52] 吴春波，周明雪，孟彦，等.非生物型人工肝的应用及研究进展[J][J].生物医学工程与临床, 2021, 25((05)):634-638
[53] 周莉，陈煜.人工肝治疗肝衰竭模式选择及其疗效判断标准[J][J].中华肝脏病杂志, 2022, 30((2)):127-130
[54] 耿华，徐曼曼，周丽华，等.血清AFP、FT3联合NLR对人工肝治疗乙型肝炎病毒相关慢加急性肝衰竭患者短期预后的评估价值研究[J][J].现代生物医学进展, 2022, 22((11)):2076-2080
[55] 马元吉，杜凌遥，白浪，等.六种预测模型对人工肝治疗的慢加急性肝衰竭患者短期预后的评估价值[J]. 四川大学学报(医学版). 2022, 53(05): 758-763.[J].四川大学学报(医学版), 2022, 53((05)):758-763
