Lan Xiaoqin, Hong Changze, Zhang Xiaofeng, Zhou Ling, Li Yuan, Zhang Caili, Mo Xingyan, Zhou Jing, Li Beiling, Qi Tingting, He Qinjun, Luo Wenfan, Lai Qintao, Ji Yali, Xu Ying, Liu Junwei, Zhou Fuyuan, Chen Jinjun
Hepatology Unit, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Nanfang Hospital, Department of Hepatology, Zengcheng Branch, Southern Medical University, Guangzhou, China.
J Gastroenterol Hepatol. 2025 Apr;40(4):940-948. doi: 10.1111/jgh.16883. Epub 2025 Jan 27.
BACKGROUND & AIMS: Acute-on-chronic liver failure (ACLF) is a complex syndrome with limited treatment options. This study aims to investigate the impact of artificial liver support system (ALSS) on the one-year prognosis of patients with Hepatitis B virus (HBV)-associated ACLF.
A retrospective study was conducted on 239 patients with HBV-ACLF in Nanfang Hospital from January 2016 to June 2021. Patients were divided into the ALSS group (n = 103) and the Standard Medical Therapy (SMT group, n = 136). Demographic, clinical, and laboratory data were collected before the first ALSS treatment for patients in ALSS group, while baseline data were collected in SMT group. According to receiving different ALSS modes, patients in ALSS group were divided into plasma exchange (PE) group and non-PE group.
The 12-week and 1-year liver transplant (LT) free survival rates in the ALSS group were significantly higher than that in the SMT group (65.05% vs 52.21%, p = 0.0011; 63.11% vs. 48.53%, p = 0.0006). ALSS therapy was the independent predictive factors associated with 12-week and 1-year mortality (hazard ratio, HR: 0.59, p = 0.04, and HR: 0.54, p = 0.01). Comparatively more ALSS-related complications were observed in PE group. After Propensity Score Matching, the 12-week and 1-year LT-free survival rates between PE and non-PE group were similar (88% vs. 80%, p = 0.227, 88% vs. 80%, p = 0.227).
ALSS therapy is a safe and effective treatment for HBV-ACLF. ALSS improves 1-year prognosis of patients with HBV-ACLF.
慢加急性肝衰竭（ACLF）是一种治疗选择有限的复杂综合征。本研究旨在探讨人工肝支持系统（ALSS）对乙型肝炎病毒（HBV）相关ACLF患者一年预后的影响。
对2016年1月至2021年6月在南方医院就诊的239例HBV-ACLF患者进行回顾性研究。患者分为ALSS组（n = 103）和标准药物治疗组（SMT组，n = 136）。收集ALSS组患者首次进行ALSS治疗前的人口统计学、临床和实验室数据，而SMT组收集基线数据。根据接受不同的ALSS模式，ALSS组患者分为血浆置换（PE）组和非PE组。
ALSS组12周和1年无肝移植（LT）生存率显著高于SMT组（65.05%对52.21%，p = 0.0011；63.11%对48.53%，p = 0.0006）。ALSS治疗是与12周和1年死亡率相关的独立预测因素（风险比，HR：0.59，p = 0.04，HR：0.54，p = 0.01）。PE组观察到相对较多的ALSS相关并发症。倾向得分匹配后，PE组和非PE组之间的12周和1年无LT生存率相似（88%对80%，p = 0.227，88%对80%，p = 0.227）。
ALSS治疗是HBV-ACLF的一种安全有效的治疗方法。ALSS改善了HBV-ACLF患者的一年预后。
