Therapeutic effect of double plasma molecular adsorption system and sequential half-dose plasma exchange in patients with HBV-related acute-on-chronic liver failure

Objective The artificial liver support system (ALSS) is used frequently as a first-line treatment for hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF). This study aims to compare the therapeutic efficacy of double plasma molecular adsorption system (DPMAS) with sequential half-dose plasma exchange (PE) (DPMAS+PE) and full-dose PE in patients with HBV-ACLF. Methods A total of 131 hospitalized patients who were diagnosed with HBV-ACLF and underwent DPMAS+PE or PE were retrospectively analyzed. According to the treatment methods used, they were divided into PE group (n = 77) and DPMAS+PE group (n = 54). The main evaluation indexes included the change of liver function and the 28-days liver transplant-free survival rates after the different treatments. Results There were no significant differences on severity of illness between PE group and DPMAS+PE group (P > 0.05). The total bilirubin (TBIL) levels immediately after treatment, and at 24 and 72 hours after treatment were markedly decreased in DPMAS+PE group than that in PE group (52.3 +/- 9.4% vs 42.3 +/- 7.2%, P < 0.05; 24.2 +/- 10.0% vs 13.5 +/- 13.0%, P < 0.05; 24.8 +/- 13.1% vs 14.9 +/- 14.9%, P < 0.05; respectively). The 28-days survival rates was 62.3% and 72.2% in PE and DPMAS+PE groups (P = 0.146). Furthermore, the 28-days survival rates were significantly higher in DPMAS+PE group than that in PE group (57.4% vs 41.7%, P = 0.043) in the intermediate-advanced stage patients. Conclusion Compared with PE alone, DPMAS+PE might more effectively improve temporary TBIL in ACLF patients, and improve the 28-days survival rates in HBV-ACLF patients with intermediate-advanced stage. Therefore, DPMAS+PE may be an available ALSS treatment for HBV-ACLF patients.