AUTHOR=Chen Yuan-yuan , Li Hai , Xu Bao-yan , Zheng Xin , Li Bei-ling , Wang Xian-bo , Huang Yan , Gao Yan-hang , Qian Zhi-ping , Liu Feng , Lu Xiao-bo , Shang Jia , Li Hai , Wang Shao-yang , Zhang Yin-hua , Meng Zhong-ji ,  Chinese Chronic Liver Failure (CLIF) Consortium , Yin Shan , Gu Wenyi , Zhang Yan , Wang Tongyu , Wu Dandan , Dong Fuchen , Zeng Bo , Chen Liuying , Wang Shijin , Zhang Qun , Hou Yixin , Li Yuxin , Huang Yunyi , Sun Shuning , Tan Wenting , Xiang Xiaomei , Dan Yunjie , Deng Guohong , Chen Jun , Liao Chengjin , Liu Xiaoxiao , Liu Jing , Xu Ling , Xiong Shue , Xiong Yan , Zou Congcong , Chen Jinjun , Zhu Congyan , Jiang Chang , Wen Xiaoyu , Gao Na , Liu Chunyan , Lei Qing , Luo Sen , Ren Haotang , Mei Xue , Wang Jiefei , Ji Liujuan , Li Tao , Fang Xuanqiong , Li Jing , Wan Ziyu , Zheng Rongjiong , Jie Fangrong , Li Nan , Jin Huiming , Li Hai , Zhang  Qing , Zheng Xuequn , Wang Shaoyang , Lin Taofa 

TITLE=Plasma Exchange-Based Non-bioartificial Liver Support System Improves the Short-Term Outcomes of Patients With Hepatitis B Virus-Associated Acute-on-Chronic Liver Failure: A Multicenter Prospective Cohort Study

JOURNAL=Frontiers in Medicine

VOLUME=8

YEAR=2021

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2021.779744

DOI=10.3389/fmed.2021.779744

ISSN=2296-858X

ABSTRACT=<p><bold>Background and aims:</bold> Hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF) is a complicated syndrome with extremely high short-term mortality. Whether plasma exchange (PE) improves HBV-ACLF outcomes remains controversial. Here, PE-based non-bioartificial liver support system (NB-ALSS) effects on short-term HBV-ACLF patient outcomes were investigated.</p><p><bold>Materials and methods:</bold> HBV-ACLF patients from Chinese Acute-on-chronic Liver Failure (CATCH-LIFE) cohort receiving standard medical therapy (SMT) alone or PE-based NB-ALSS in addition to SMT were allocated to SMT and SMT+PE groups, respectively; propensity score matching (PSM) was used to eliminate confounding bias. Short-term (28/90-day and 1-year) survival rates were calculated (Kaplan-Meier).</p><p><bold>Results:</bold> In total, 524 patients with HBV-ACLF were enrolled in this study; 358 received SMT alone (SMT group), and the remaining 166 received PE-based NB-ALSS in addition to SMT (SMT+PE group). PSM generated 166 pairs of cases. In the SMT+PE group, 28-day, 90-day, and 1-year survival rates were 11.90, 8.00, and 10.90%, respectively, higher than those in the SMT group. Subgroup analysis revealed that PE-based NB-ALSS had the best efficacy in patients with ACLF grade 2 or MELD scores of 30–40 (MELD grade 3). In MELD grade 3 patients who received SMT+PE, 28-day, 90-day, and 1-year survival rates were improved by 18.60, 14.20, and 20.10%, respectively. According to multivariate Cox regression analysis, PE-based NB-ALSS was the only independent protective factor for HBV-ACLF patient prognosis at 28 days, 90 days, and 1 year (28 days, HR = 0.516, <italic>p</italic> = 0.001; 90 days, HR = 0.663, <italic>p</italic> = 0.010; 1 year, HR = 0.610, <italic>p</italic> = 0.051). For those who received SMT+PE therapy, PE-based NB-ALSS therapy frequency was the only independent protective factor for short-term prognosis (28-day, HR = 0.597, <italic>p</italic> = 0.001; 90-day, HR = 0.772, <italic>p</italic> = 0.018).</p><p><bold>Conclusions:</bold> This multicenter prospective study showed that the addition of PE-based NB-ALSS to SMT improves short-term (28/90 days and 1-year) outcomes in patients with HBV-ACLF, especially in MELD grade 3 patients. Optimization of PE-based NB-ALSS may improve prognosis or even save lives among HBV-ACLF patients.</p>