Dai Zhong-Shang, Zhang Min, Deng Yuan-Ye, Zhou Ning, Tian Yi
Department of Infectious Diseases, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China.
World J Gastroenterol. 2025 Apr 14;31(14):103892. doi: 10.3748/wjg.v31.i14.103892.
We have innovatively amalgamated membrane blood purification and centrifugal blood cell separation technologies to address the limitations of current artificial liver support (ALS) models, and develop a versatile plasma purification system (VPPS) through centrifugal plasma separation.
To investigate the influence of VPPS on long-term rehospitalization and mortality rates among patients with acute-on-chronic liver failure (ACLF).
This real-world, prospective study recruited inpatients diagnosed with ACLF from the Second Xiangya Hospital of Central South University between October 2021 and March 2024. Patients were categorized into the VPPS and non-VPPS groups based on the distinct ALS models administered to them. Self-administered questionnaires, clinical records, and self-reported data served as the primary methods for data collection. The laboratory results were evaluated at six distinct time points. All patients were subjected to follow-up assessments for > 12 months. Kaplan-Meier survival analyses and Cox proportional hazards models were used to evaluate the risks of hospitalization and mortality during the follow-up period.
A cohort of 502 patients diagnosed with ACLF was recruited, with 260 assigned to the VPPS group. On comparing baseline characteristics, the VPPS group exhibited a significantly shorter length of stay, higher incidence of spontaneous peritonitis and pulmonary aspergillosis compared to the non-VPPS group ( < 0.05). Age [hazard ratio (HR) = 1.142, 95%CI: 1.01-1.23, = 0.018), peritonitis (HR = 2.825, 95%CI: 1.07-6.382, = 0.026), albumin (HR = 0.67, 95%CI: 0.46-0.942, = 0.023), total bilirubin (HR = 1.26, 95%CI: 1.01-3.25, = 0.021), international normalized ratio (HR = 1.97, 95%CI: 1.21-2.908, = 0.014), and VPPS/non-VPPS (HR = 3.24, 95%CI: 2.152-4.76, < 0.001) were identified as significant independent predictors of mortality in both univariate and multivariate analyses throughout the follow-up period. Kaplan-Meier survival analyses demonstrated significantly higher rehospitalization and mortality rates in the non-VPPS group compared to the VPPS group during follow-up of ≥ 2 years (log-rank test, < 0.001).
These findings suggest that VPPS is safe and has a positive influence on prognostic outcomes in patients with ACLF.
我们创新性地融合了膜式血液净化和离心式血细胞分离技术，以解决当前人工肝支持（ALS）模型的局限性，并通过离心式血浆分离开发了一种通用型血浆净化系统（VPPS）。
探讨VPPS对慢性肝衰竭急性发作（ACLF）患者长期再住院率和死亡率的影响。
这项真实世界的前瞻性研究纳入了2021年10月至2024年3月期间在中南大学湘雅二医院被诊断为ACLF的住院患者。根据给予患者的不同ALS模型，将患者分为VPPS组和非VPPS组。自行填写的问卷、临床记录和自我报告的数据是数据收集的主要方法。在六个不同时间点评估实验室结果。所有患者均接受了超过12个月的随访评估。采用Kaplan-Meier生存分析和Cox比例风险模型评估随访期间的住院和死亡风险。
招募了一组502例被诊断为ACLF的患者，其中260例被分配到VPPS组。比较基线特征时，与非VPPS组相比，VPPS组的住院时间明显更短，自发性腹膜炎和肺曲霉病的发生率更高（P<0.05）。年龄[风险比（HR）=1.142，95%置信区间：1.01-1.23，P=0.018]、腹膜炎（HR=2.825，95%置信区间：1.07-6.382，P=0.026）、白蛋白（HR=0.67，95%置信区间：0.46-0.942，P=0.023）、总胆红素（HR=1.26，95%置信区间：1.01-3.25，P=0.021）、国际标准化比值（HR=1.97，95%置信区间：1.21-2.908，P=0.014）以及VPPS/非VPPS（HR=3.24，95%置信区间：2.152-4.76，P<0.001）在整个随访期间的单因素和多因素分析中均被确定为死亡率的显著独立预测因素。Kaplan-Meier生存分析表明，在≥2年的随访期间，非VPPS组的再住院率和死亡率明显高于VPPS组（对数秩检验，P<0.001）。
这些发现表明VPPS是安全的，并且对ACLF患者的预后结果有积极影响。
