Combined use of non-biological artificial liver treatments for patients with acute liver failure complicated by multiple organ dysfunction syndrome

doi:10.5847/wjem.j.issn.1920-8642.2014.03.010

Abstract

Abstract:

BACKGROUND: Acute liver failure (ALF) caused by viral and non-viral hepatitis is often accompanied with severe metabolic disorders, the accumulation of toxic substances and continuous release and accumulation of a large number of endogenous toxins and inflammatory mediators. The present study aimed to investigate the effects of various combined non-biological artificial liver treatments for patients with acute liver failure (ALF) complicated by multiple organ dysfunction syndrome (MODS).
METHODS: Thirty-one patients with mid- or late-stage liver failure complicated by MODS (score 4) were randomly divided into three treatment groups: plasmapheresis (PE) combined with hemoperfusion (HP) and continuous venovenous hemodiafiltration (CVVHDF), PE+CVVHDF, and HP+CVVHDF, respectively. Heart rate (HR) before and after treatment, mean arterial pressure (MAP), respiratory index (PaO₂/FiO₂), hepatic function, platelet count, and blood coagulation were determined.
RESULTS: Significant improvement was observed in HR, MAP, PaO₂/FiO₂, total bilirubin (TBIL) and alanine aminotransferase (ALT) levels after treatment (P<0.05). TBIL and ALT decreased more significantly after treatment in the PE+CVVHDF and PE+HP+CVVHDF groups (P<0.01). Prothrombin time (PT) and albumin were significantly improved only in the PE+CVVHDF and PE+HP+CVVHDF groups (P<0.05). TBIL decreased more significantly in the PE+HP+CVVHDF group than in the HP+CVVHDF and PE+CVVHDF groups (P<0.05). The survival rate of the patients was 58.1% (18/31), viral survival rate 36.4% (4/11), and non-viral survival rate 70% (14/20).
CONCLUSION: Liver function was relatively improved after treatment, but PE+HP+CVVHDF was more efficient for the removal of toxic metabolites, especially bilirubin. The survival rate was significantly higher in the patients with non-viral liver failure than in those with viral liver failure.

Key words: Severe acute liver failure, Artificial liver, Plasma exchange, Hemoperfusion, Continuous veno-venous hemodiafiltration

Mao-qin Li, Jun-xiang Ti, Yun-hang Zhu, Zai-xiang Shi, Ji-yuan Xu, Bo Lu, Jia-qiong Li, Xiao-meng Wang, Yan-jun Xu. Combined use of non-biological artificial liver treatments for patients with acute liver failure complicated by multiple organ dysfunction syndrome[J]. World Journal of Emergency Medicine, 2014, 5(3): 214-217.

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References 10

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Groups	n	Age (y)	SOFA score	Treatment time (h)
HP+CVVHDF	32	40.1±16.71	13.44±3.09	17.7±5.67
PE+CVVHDF	26	37.7±14.59	13.39±3.26	19.2±6.02
PE+HP+CVVHDF	23	35.9±18.55	14.14±3.68	18.9±4.98

Groups	n	HR (beats/minute)	MAP (mmHg)	PaO₂/FiO₂	PLT (×10⁹/L)
HP+CVVHDF	32
Pre-treatment		136±21.22	80.10±15.57	226±78.83	79.28±42.29
Post-treatment		119±27.01^*	91.03±10.89^*	291±50.13^*	74.46±43.87
PE+CVVHDF	26
Pre-treatment		134±20.71	79.41±13.83	217±71.96	83.17±45.13
Post-treatment		117±24.54^*	91.39±12.26^*	299±57.24^*	77.81±40.22
PE+HP+CVVHDF	32
Pre-treatment		140±24.23	81.44±12.46	203±69.11	85.89±51.21
Post-treatment		109±25.51^*﹟	92.74±11.34^*	314±61.02^a﹟	76.31±46.65

Groups	n	PT (s)	TBIL (μmol/L)	ALT (μ/L)	ALB (g/L)
HP+CVVHDF	32
Pre-treatment		26.33±14.99	367.58±155.77	379.32±249.45	29.12±5.78
Post-treatment		22.07±12.11	317.44±145.02^*	144.37±162.16^﹟	28.34±5.31
PE+CVVHDF	26
Pre-treatment		26.95±16.02	359.61±147.17	348.79±287.22	27.98±4.60
Post-treatment		19.76±10.03^*	275.47±133.52^*	137.45±139.31^﹟	29.75±4.88^*
PE+HP+CVVHDF	23
Pre-treatment		28.09±15.26	387.18±165.92	325.32±209.66	28.83±4.55
Post-treatment		19.34±11.15^*	257.44±150.24^﹟Δ	128.35±118.92^﹟	30.33±5.14^*

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