Coirier Valentin, Quelven Quentin, Guillot Pauline, Delamaire Flora, Houssel-Debry Pauline, Maamar Adel, Painvin Benoît, Gacouin Arnaud, Lesouhaitier Mathieu, Rayar Michel, Grulois Isabelle, Terzi Nicolas, Tadié Jean-Marc, Camus Christophe
Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France.
Université de Rennes, Faculté de Médecine, Rennes, France.
J Clin Exp Hepatol. 2025 Jan-Feb;15(1):101934. doi: 10.1016/j.jceh.2024.101934. Epub 2024 Jul 15.
Acute liver failure (ALF) is a condition that mostly requires Intensive Care Unit (ICU) admission and sometimes necessitates emergency liver transplantation. High-volume plasma exchange (HVPE) may improve transplant-free survival (TFS) in ALF. Our study assessed complications of HVPE therapy and outcome in ALF patients.
We conducted a single-center retrospective study of all patients admitted to the ICU for ALF and who underwent HVPE between June 2016 and June 2021. The plasmapheresis technique used was centrifugation, and the volume exchanged was calculated as 15% of the ideal body weight. Dedicated staff prospectively collected clinical adverse effects, while biological data were retrospectively collected. The primary outcome was the rate of severe adverse effects (SAE, defined as severe manifestations of hypotension, allergy, metabolic disturbances or other life-threatening event) that occurred during HVPE sessions. Factors influencing day-21 TFS were also studied.
One hundred twenty sessions were performed in 50 patients. The main etiology for ALF was paracetamol (52% of the patients). During the session, hemoglobin, platelet, transaminases, ammonia and bilirubin decreased, coagulation factors increased, and creatinine and lactate remained unchanged. At least one SAE was reported for 32 out of 120 sessions (26.7% [19%-35.5%], mostly severe alkalosis [24/117], hypotension [4/120] and hypocalcemia [4/119]). Arterial pH ≤ 7.43 following HVPE and paracetamol etiology were negatively and positively associated with day-21 TFS, respectively.
Severe adverse effects were frequent during HVPE performed for ALF, mainly severe alkalosis, hypotension and hypocalcemia. Post-HVPE, pH and paracetamol etiology were prognosis markers.
急性肝衰竭（ALF）是一种大多需要入住重症监护病房（ICU），有时还需要进行紧急肝移植的病症。大容量血浆置换（HVPE）可能会改善ALF患者的无移植生存率（TFS）。我们的研究评估了HVPE治疗的并发症及ALF患者的预后。
我们对2016年6月至2021年6月期间因ALF入住ICU并接受HVPE治疗的所有患者进行了单中心回顾性研究。所采用的血浆置换技术为离心法，置换量按理想体重的15%计算。专业工作人员前瞻性收集临床不良反应，生物数据则进行回顾性收集。主要结局是HVPE治疗期间发生的严重不良反应（SAE，定义为低血压、过敏、代谢紊乱或其他危及生命事件的严重表现）发生率。还研究了影响第21天TFS的因素。
对50例患者进行了120次治疗。ALF的主要病因是对乙酰氨基酚（占患者的52%）。治疗期间，血红蛋白、血小板、转氨酶、氨和胆红素水平下降，凝血因子增加，肌酐和乳酸水平保持不变。120次治疗中有32次（26.7%[19%-35.5%]）报告了至少1次SAE，主要是严重碱中毒（24/117）、低血压（4/120）和低钙血症（4/119）。HVPE后动脉pH≤7.43与对乙酰氨基酚病因分别与第21天TFS呈负相关和正相关。
在对ALF进行HVPE治疗期间，严重不良反应很常见，主要是严重碱中毒、低血压和低钙血症。HVPE后，pH值和对乙酰氨基酚病因是预后指标。
