Gasca-Aldama Jose Carlos, Castrejón-Sánchez Jesús Enrique, Carrasco Flores Mario A, Vásquez-Jiménez Enzo, Carpinteyro-Espin Paulina, Pérez-Escobar Juanita, Gutierrez-Toledo Karlos Dhamian, Galindo Pablo E, Vidals-Sanchez Marcos, Costa-Urrutia Paula
Department of Intensive Care Unit, Hospital Juárez de Mexico, Ciudad de Mexico 07760, Mexico.
Department of Nephrology, Hospital Juárez de Mexico, Ciudad de Mexico 07760, Mexico.
Healthcare (Basel). 2025 Aug 20;13(16):2059. doi: 10.3390/healthcare13162059.
: Acute liver failure (ALF) is a life-threatening condition with high mortality in nontransplant candidates. Therapeutic plasma exchange (TPE) has emerged as a promising intervention for removing inflammatory mediators and toxic metabolites. In Latin America, data on the efficacy of TPE in ALF patients are limited. This real-world study aimed to compare 30-day survival outcomes between patients receiving standard medical treatment (SMT) and those receiving SMT plus TPE. We analyzed 25 ALF patients admitted to the tertiary intensive care unit (ICU) of Hospital Juárez of Mexico City, Mexico, from 2018 to 2024. Patients received either standard medical treatment (SMT group, n = 12) or SMT with TPE (TPE group, n = 13), including high-volume TPE (n = 8) and standard-volume TPE (n = 5). Survival analysis was performed via Kaplan-Meier estimates, and binomial regression analysis was run to estimate the mortality probability stratified by the hepatic encephalopathy grade. Results: At 30 days, survival was significantly greater in the TPE group (92%) than in the SMT group (50%) ( = 0.02). The greatest survival benefit was observed in patients with Grade 4 encephalopathy. The ICU stay was longer in the TPE group, reflecting the complexity of ALF management. TPE significantly improves 30-day survival in ALF patients compared with SMT alone, supporting its role as an adjunct therapy. Further studies are needed to refine patient selection and optimize treatment protocols.
急性肝衰竭（ALF）是一种危及生命的疾病，对于不适合进行肝移植的患者来说死亡率很高。治疗性血浆置换（TPE）已成为一种有前景的干预措施，用于清除炎症介质和有毒代谢产物。在拉丁美洲，关于TPE对ALF患者疗效的数据有限。这项真实世界研究旨在比较接受标准药物治疗（SMT）的患者与接受SMT加TPE的患者的30天生存结局。我们分析了2018年至2024年期间入住墨西哥城华雷斯医院三级重症监护病房（ICU）的25例ALF患者。患者接受标准药物治疗（SMT组，n = 12）或SMT联合TPE（TPE组，n = 13），其中包括大容量TPE（n = 8）和标准容量TPE（n = 5）。通过Kaplan-Meier估计进行生存分析，并进行二项式回归分析以估计按肝性脑病分级分层的死亡概率。结果：30天时，TPE组的生存率（92%）显著高于SMT组（50%）（P = 0.02）。在4级脑病患者中观察到最大的生存获益。TPE组的ICU住院时间更长，这反映了ALF管理的复杂性。与单独的SMT相比，TPE显著提高了ALF患者的30天生存率，支持其作为辅助治疗的作用。需要进一步研究以优化患者选择并完善治疗方案。
