Kumar Santhosh E, Goel Ashish, Zachariah Uday, Nair Sukesh C, David Vinoi G, Varughese Santosh, Gandhi Prashanth B, Barpha Amit, Sharma Anand, Vijayalekshmi Balakrishnan, Balasubramanian Kunissery A, Elias Elwyn, Eapen Chundamannil Eapen
Departments of Hepatology, Christian Medical College, Vellore, Tamil Nadu, India.
Transfusion Medicine and Immunohematology, Christian Medical College, Vellore, Tamil Nadu, India.
J Clin Exp Hepatol. 2022 Mar-Apr;12(2):372-378. doi: 10.1016/j.jceh.2021.07.010. Epub 2021 Jul 21.
Alcohol-related acute on chronic liver failure (A-ACLF) patients have high short-term mortality and are poor candidates for steroid therapy. Plasma exchange (PLEX) improves survival in ACLF patients. We analyzed our experience with low volume PLEX (50% of plasma volume exchanged per session) and low dose steroids to treat A-ACLF patients.
We retrospectively compared the efficacy of low volume PLEX and low-dose steroids with standard medical treatment (SMT) in A-ACLF patients treated at our center between November 2017 to June 2019. The primary study outcome was one-year survival.
Twenty-one A-ACLF patients in PLEX group [age 40 (29-56) years, median (range); MELD score 31 (29-46)] and 29 A-ACLF patients in SMT group [age 41.5 (28-63) years, MELD score 37 (21-48)] were studied. All 50 study patients had severe alcoholic hepatitis [mDF 84.7 (50-389)]. PLEX group patients had 3 (1-7) PLEX sessions with 1.5 (1.4-1.6) liters of plasma exchanged per session and oral Prednisolone 20 mg daily, tapered over 1 month. Kaplan Meier analysis showed better survival over 1 year in the PLEX group compared to the SMT group ( = 0.03). There was renal dysfunction in 10 patients in the PLEX group, which normalized in six patients after PLEX.
In this preliminary report, compared to SMT, low volume PLEX and low dose steroid improved survival over one year in A-ACLF patients with severe alcoholic hepatitis. In patients with renal dysfunction, 60% showed improvement in renal function with PLEX. Studies with a larger number of patients are needed to validate these results.
酒精性慢加急性肝衰竭（A-ACLF）患者短期死亡率高，且不是类固醇治疗的合适人选。血浆置换（PLEX）可提高ACLF患者的生存率。我们分析了采用小容量PLEX（每次置换50%血浆量）和低剂量类固醇治疗A-ACLF患者的经验。
我们回顾性比较了2017年11月至2019年6月在本中心接受治疗的A-ACLF患者中，小容量PLEX和低剂量类固醇与标准药物治疗（SMT）的疗效。主要研究结局为一年生存率。
研究了PLEX组的21例A-ACLF患者[年龄40（29-56）岁，中位数（范围）；终末期肝病模型（MELD）评分31（29-46）]和SMT组的29例A-ACLF患者[年龄41.5（28-63）岁，MELD评分37（21-48）]。所有50例研究患者均患有严重酒精性肝炎[mDF 84.7（50-389）]。PLEX组患者接受3（1-7）次PLEX治疗，每次置换1.5（1.4-1.6）升血浆，并每日口服20毫克泼尼松龙，1个月内逐渐减量。Kaplan Meier分析显示，与SMT组相比，PLEX组1年生存率更高（P = 0.03）。PLEX组有10例患者出现肾功能不全，其中6例在接受PLEX治疗后肾功能恢复正常。
在这份初步报告中，与SMT相比，小容量PLEX和低剂量类固醇可提高重度酒精性肝炎A-ACLF患者的一年生存率。在肾功能不全患者中，60%的患者接受PLEX治疗后肾功能有所改善。需要更多患者参与的研究来验证这些结果。
