Cui Kunping, Liu Chang-Hai, Teng Xiangnan, Chen Fang, Xu Yan, Zhou Shaoqun, Yang Qi, Du Lingyao, Ma YuanJi, Bai Lang
Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China.
Infect Drug Resist. 2025 Jan 6;18:113-126. doi: 10.2147/IDR.S500291. eCollection 2025.
The artificial liver support system (ALSS) has been recruited as an available method for patients with acute-on-chronic liver failure (ACLF), but its impact on the outcome of ACLF remains controversial. This study aimed to investigate the association between ALSS treatment and short-term prognosis of hepatitis B-related ACLF (HBV-ACLF).
This was a retrospective observational cohort study, and data were obtained from the Center of Infectious Diseases, West China Hospital of Sichuan University, between Mar 2015 and December 2021. The primary outcome was 28-day transplant-free mortality and the secondary outcomes were 60- and 90-day transplant-free mortality. Patients were divided into standard medical therapy (SMT) and ALSS groups. Kaplan-Meier survival analysis curves show the 28-day, 60-day and 90-day transplant-free mortality. Based on the feature selection result of univariate logistic, univariate Cox and Boruta algorithm, the univariate and multivariate logistic and COX regression models were used to investigate the association of ALSS with 28-day, 60-day and 90-day outcomes in patients with HBV-ACLF. Subgroup analyses were conducted to test the robustness of the results.
A total of 589 hBV-ACLF patients were enrolled in this study (median age, 48.00 years [IQR,44.00-55.00 years]; 70 [11.9%] female). The 28-day, 60-day and 90-day transplant-free mortality rates were 25.6%, 35.8% and 38.9%, respectively. In the univariate and Kaplan-Meier survival analysis, ALSS could significantly reduce 28-day, 60-day and 90-day transplant-free mortality compared to SMT. Furthermore, an in-depth analysis of our study revealed that the therapeutic benefits of the ALSS were observed exclusively within the end-stage (PT-INR ≥ 2.5) subgroup of HBV-ACLF patients.
Compared to SMT, ALSS demonstrated efficacy primarily in enhancing the short- term prognosis of end-stage HBV-ACLF patients, rather than across the entire spectrum of HBV-ACLF patients.
人工肝支持系统（ALSS）已被用作治疗慢性肝功能衰竭急性发作（ACLF）患者的一种可行方法，但其对ACLF患者预后的影响仍存在争议。本研究旨在探讨ALSS治疗与乙型肝炎相关ACLF（HBV-ACLF）患者短期预后之间的关联。
这是一项回顾性观察队列研究，数据来自2015年3月至2021年12月四川大学华西医院传染病中心。主要结局是28天无移植死亡率，次要结局是60天和90天无移植死亡率。患者分为标准药物治疗（SMT）组和ALSS组。Kaplan-Meier生存分析曲线显示28天、60天和90天无移植死亡率。基于单因素逻辑回归、单因素Cox回归和Boruta算法的特征选择结果，采用单因素和多因素逻辑回归及COX回归模型，研究ALSS与HBV-ACLF患者28天、60天和90天结局的关联。进行亚组分析以检验结果的稳健性。
本研究共纳入589例HBV-ACLF患者（中位年龄48.00岁[四分位间距，44.00 - 55.00岁]；70例[11.9%]为女性）。28天、60天和90天无移植死亡率分别为25.6%、35.8%和38.9%。在单因素和Kaplan-Meier生存分析中，与SMT相比，ALSS可显著降低28天、60天和90天无移植死亡率。此外，对本研究的深入分析表明，仅在HBV-ACLF患者的终末期（PT-INR≥2.5）亚组中观察到ALSS的治疗益处。
与SMT相比，ALSS主要在改善终末期HBV-ACLF患者的短期预后方面显示出疗效，而非在整个HBV-ACLF患者范围内均有效。
