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Outcome of patients with different stages of acute-on-chronic liver failure treated with artificial liver support system.
Ma, Yuanji; Xu, Yan; Du, Lingyao; Bai, Lang; Tang, Hong.
Afiliación
  • Ma Y; Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China.
  • Xu Y; Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China.
  • Du L; Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China.
  • Bai L; Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China.
  • Tang H; Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China.
Front Med (Lausanne) ; 11: 1381386, 2024.
Article en En | MEDLINE | ID: mdl-38835796
ABSTRACT

Background:

Elevated international normalized ratio of prothrombin time (PT-INR) is one of the key characteristics of acute-on-chronic liver failure (ACLF). Whether the staging of PT-INR has the ability to screen out subgroups of ACLF patients who would be more eligible for artificial liver support system (ALSS) treatment has not been studied in detail.

Methods:

A previous study enrolled patients receiving ALSS treatment with regional citrate anticoagulation from January 2018 to December 2019. Patients with different PT-INR intervals were retrospectively enrolled 1.3 ≤ PT-INR < 1.5 (Pre-stage), 1.5 ≤ PT-INR < 2.0 (Early-stage), 2.0 ≤ PT-INR < 2.5 (Mid-stage), and PT-INR ≥ 2.5 (End-stage). The Cox proportional hazards models were used to estimate the association between stages of ACLF or sessions of ALSS treatment and 90 day mortality.

Results:

A total of 301 ACLF patients were enrolled. The 90 day mortality risk of Early-stage ACLF patients (adjusted hazard ratio (aHR) (95% confidence interval (CI)), 3.20 (1.15-8.89), p = 0.026), Mid-stage ACLF patients (3.68 (1.34-10.12), p = 0.011), and End-stage ACLF patients (12.74 (4.52-35.91), p < 0.001) were higher than that of Pre-stage ACLF patients, respectively. The 90 day mortality risk of Mid-stage ACLF patients was similar to that of Early-stage ACLF patients (1.15 (0.69-1.94), p = 0.591). The sessions of ALSS treatment was an independent protective factor (aHR (95% CI), 0.81 (0.73-0.90), p < 0.001). The 90 day mortality risk in ACLF patients received 3-5 sessions of ALSS treatment was lower than that of patients received 1-2 sessions (aHR (95% CI), 0.34 (0.20-0.60), p < 0.001), whereas the risk in patients received ≥6 sessions of ALSS treatment was similar to that of patients received 3-5 sessions (0.69 (0.43-1.11), p = 0.128).

Conclusion:

ACLF patients in Pre-, Early-, and Mid-stages might be more eligible for ALSS treatment. Application of 3-5 sessions of ALSS treatment might be reasonable.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Front Med (Lausanne) Año: 2024 Tipo del documento: Article País de afiliación: China Pais de publicación: Suiza
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Front Med (Lausanne) Año: 2024 Tipo del documento: Article País de afiliación: China Pais de publicación: Suiza