评估小剂量治疗性血浆置换在实现黄磷中毒性急性肝功能衰竭恢复中的临床疗效。

Assessing the clinical efficacy of low-volume therapeutic plasma exchange in achieving recovery from acute liver failure induced by yellow phosphorous poisoning.

机构信息

Department of Immunohaematology and Blood Transfusion, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.

Department of Critical Care Medicine, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.

出版信息

J Clin Apher. 2024 Jun;39(3):e22110. doi: 10.1002/jca.22110.

DOI:10.1002/jca.22110

PMID:38634432

Abstract

BACKGROUND

Acute liver failure (ALF) following yellow phosphorous (YP) ingestion is similar to acetaminophen-induced ALF and it has become a public concern in our region. This study assessed low volume therapeutic plasma exchange (LV-TPE) efficacy in improving the transplant free survival in YP poisoning.

METHODS

Adult patients with toxicology reports of YP and ALF requiring critical care were included in the study. LV-TPE was planned for three consecutive days and three more if required. Performed 1.3 to 1.5 plasma volume replacing with 0.9% normal saline, 5% human albumin solution, and fresh frozen plasma based on ASFA 2019 criteria. MELD score, laboratory parameters, LV-TPE details were captured. The study end point was clinical outcome of the patients.

RESULTS

Among 36 patients, 19 underwent LV-TPE and 17 opted out of LV-TPE and they were included as a control arm. The MELD score was 32.64 ± 8.05 and 37.83 ± 9.37 in both groups. There were 13 survivors in LV-TPE group leading to a 68.42% reduction in mortality. The coagulation and biochemical parameters showed a significant percentage change after LV-TPE. Refractory shock, delay in initiating procedure and acidosis were independent predictors of mortality.

CONCLUSION

A well-timed LV-TPE improves the survival of patients with ALF due to YP poisoning.

摘要

背景

黄磷（YP）摄入后导致的急性肝衰竭（ALF）类似于对乙酰氨基酚引起的 ALF，这在我们地区引起了公众关注。本研究评估了小体积治疗性血浆置换（LV-TPE）在改善YP 中毒所致 ALF 患者无肝移植存活率方面的疗效。

方法

纳入有 YP 中毒和 ALF 需要重症监护的毒理学报告的成年患者。计划连续 3 天进行 LV-TPE，如果需要则再进行 3 天。根据 ASFA 2019 标准，用 0.9%生理盐水、5%人血白蛋白溶液和新鲜冷冻血浆置换 1.3 至 1.5 个血浆容量。记录 MELD 评分、实验室参数和 LV-TPE 细节。研究终点为患者的临床结局。

结果

在 36 名患者中，19 名接受了 LV-TPE，17 名患者选择不接受 LV-TPE，他们被纳入对照组。LV-TPE 组和对照组的 MELD 评分分别为 32.64±8.05 和 37.83±9.37。LV-TPE 组有 13 名幸存者，死亡率降低了 68.42%。凝血和生化参数在 LV-TPE 后显示出显著的百分比变化。难治性休克、延迟开始治疗和酸中毒是死亡率的独立预测因素。