Efficacy of a novel artificial liver versatile plasma purification system in patients with acute-on-chronic liver failure.

BACKGROUND

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.

AIM

To investigate the influence of VPPS on long-term rehospitalization and mortality rates among patients with acute-on-chronic liver failure (ACLF).

METHODS

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.

RESULTS

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).

CONCLUSION

These findings suggest that VPPS is safe and has a positive influence on prognostic outcomes in patients with ACLF.