Yang Lingling, Wu Tianzhou, Li Jiang, Xin Jiaojiao, Shi Dongyan, Jiang Jing, Liang Xi, Lu Yingyan, Yao Heng, Zhang Huafen, Sun Suwan, Li Tan, Mohamed Hassan Mohamed Hozeifa, Li Jiaqi, Ren Keke, Guo Beibei, Zhou Xingping, Chen Jiaxian, Hao Shaorui, Chen Jiajia, Xin Shaojie, Pan Chen, Han Tao, Chen Yongping, Lin Shumei, Duan Zhongping, Xu Xiaowei, Huang Jianrong, Chen Xin, Li Lanjuan, Li Jun
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Precision Medicine Center, Taizhou Central Hospital, Taizhou University Medical School, Taizhou, China.
Hepatol Res. 2020 Jun;50(6):656-670. doi: 10.1111/hepr.13497. Epub 2020 Mar 31.
The artificial liver support system (ALSS) is recognized as a bridge to liver transplantation in hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) patients. However, patient survival remains unknown. We aim to assess the effects of ALSS on survival in HBV-ACLF patients.
The clinical data of HBV-ACLF patients receiving standard medical treatment (SMT) plus ALSS (ALSS group, n = 507) or only SMT (SMT group, n = 417) were collected for survival assessment. The main end-points were cumulative survival rates at days 21, 28, and 90. Four different rigorous analyses were carried out to reduce bias and confounding.
In the entire cohort, the cumulative survival rates at days 21, 28, and 90 were significantly higher in patients who underwent ALSS treatment (73.3% vs. 59.6%, 69.2% vs. 56.6%, 56.5% vs. 49.1%, respectively, P < 0.01) than in those who underwent SMT only. In the 276-pair case-control matched cohort, a significantly higher survival rate was also observed in the ALSS group than in the SMT group on days 21, 28, and 90 (72.5% vs. 60.3%, 68.3% vs. 57.4%, 55.9% vs. 48.5%, respectively, P < 0.05), especially in patients with ACLF-1 and -2. By a multivariable-adjusted analysis, ALSS treatment was associated with a significantly lower risk of mortality, especially for ACLF-2 at days 21, 28, and 90. These findings were also confirmed through propensity score matching and inverse probability treatment weighting analysis.
ALSS treatment can improve short-term survival and is associated with a significantly lower risk of short-term mortality in patients with HBV-ACLF, especially ACLF-2.
人工肝支持系统（ALSS）被认为是乙型肝炎病毒相关慢加急性肝衰竭（HBV-ACLF）患者肝移植的桥梁。然而，患者的生存率仍然未知。我们旨在评估ALSS对HBV-ACLF患者生存率的影响。
收集接受标准药物治疗（SMT）联合ALSS（ALSS组，n = 507）或仅接受SMT（SMT组，n = 417）的HBV-ACLF患者的临床数据进行生存评估。主要终点是第21、28和90天的累积生存率。进行了四种不同的严格分析以减少偏倚和混杂因素。
在整个队列中，接受ALSS治疗的患者在第21、28和90天的累积生存率显著高于仅接受SMT的患者（分别为73.3%对59.6%、69.2%对56.6%、56.5%对49.1%，P < 0.01）。在276对病例对照匹配队列中，ALSS组在第21、28和90天的生存率也显著高于SMT组（分别为72.5%对60.3%、68.3%对57.4%、55.9%对48.5%，P < 0.05），尤其是在ACLF-1和-2患者中。通过多变量调整分析，ALSS治疗与显著较低的死亡风险相关，尤其是在第21、28和90天的ACLF-2患者中。这些发现也通过倾向评分匹配和逆概率处理加权分析得到证实。
ALSS治疗可提高HBV-ACLF患者的短期生存率，并与显著较低的短期死亡风险相关，尤其是ACLF-2患者。
