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Artificial Liver Treatment Improves Survival in Patients with Acute-on-Chronic Liver Failure

38 Pages Posted: 9 Oct 2019

See all articles by Lingling Yang

Lingling Yang

Zhejiang University - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases

Tianzhou Wu

Taizhou University

Jiang Li

Zhejiang University - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases

Jiaojiao Xin

Zhejiang University - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases

Dongyan Shi

Zhejiang University - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases

Jing Jiang

Zhejiang University - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases

Xi Liang

Taizhou University

Yingyan Lu

Tongde Hospital of Zhejiang Province

Heng Yao

Zhejiang University - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases

Huafen Zhang

Zhejiang University - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases

Suwan Sun

Zhejiang University - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases

Tan Li

Zhejiang University - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases

Hozeifa Mohamed Hassan Mohamed

Zhejiang University - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases

Jiaqi Li

Zhejiang University - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases

Keke Ren

Zhejiang University - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases

Beibei Guo

Zhejiang University - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases

Xingping Zhou

Zhejiang University - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases

Jiaxian Chen

Zhejiang University - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases

Shaorui Hao

Zhejiang University - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases

Jiajia Chen

Zhejiang University - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases

Shaojie Xin

Government of the People's Republic of China - People's Liberation Army (PLA)

Chen Pan

Fujian Medical University - Mengchao Hepatobiliary Hospital

Tao Han

Tianjin Third Central Hospital

Yongping Chen

Wenzhou Medical University - Department of Infectious and Liver Diseases

Shumei Lin

Xi'an Jiaotong University (XJTU)

Zhongping Duan

Capital Medical University

Xiaowei Xu

Zhejiang University - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases

Jianrong Huang

Zhejiang University - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases

Xin Chen

Taizhou University

Lanjuan Li

Zhejiang University - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases

Jun Li

Zhejiang University - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases; Zhejiang University - School of Medicine

Chinese Group on the Study of Severe Hepatitis B (COSSH) Group

Independent

More...

Abstract

Background: The artificial liver support system (ALSS) is recognized as a bridge to liver transplantation (LT) in hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) patients; however, its impact on patient survival remains unknown. This study aimed to assess the effects of ALSS on survival in patients with HBV-ACLF.

Methods: The clinical data of HBV-ACLF patients receiving standard medical treatment (SMT) plus ALSS (ALSS group, n = 507) or only SMT (SMT group, n = 417) were collected for survival assessment. The main endpoints were cumulative survival rates at days 21, 28 and 90. A case-control matched analysis was used to reduce bias between the ALSS and SMT groups. A propensity score matching (PSM) and inverse probability treatment weighting (IPTW) analysis were performed to confirm the survival effect of ALSS.

Findings: In the entire cohort, the cumulative survival rates at days 21, 28 and 90 were significantly higher in patients who underwent ALSS treatment (73.3% vs. 59.6%, 69.2% vs. 56.6%, 56.5% vs. 49.1%, respectively, P <0.01) than in those who underwent SMT only. In the 276-pair case-control matched cohort, a significantly higher survival rate was also observed in the ALSS group than in the SMT group on days 21, 28 and 90 (72.5% vs. 60.3%, 68.3% vs. 57.4%, 55.9% vs. 48.5%, respectively, P <0.05), especially in patients with ACLF-1 and -2. By a multivariable-adjusted analysis, ALSS treatment was associated with a significantly lower risk of mortality, especially for ACLF-2 at days 21, 28 and 90 (HR: 0.587, 0.596 and 0.640, respectively). These findings were also confirmed through PSM and IPTW analysis (HR: 0.482/0.538 and 0.538/0.552 at day 21/28, respectively, P <0.01).

Interpretation: Compared with SMT, ALSS treatment improved the short-term survival and was associated with a significantly lower risk of short-term mortality in patients with HBV-ACLF, especially ACLF-2.

Funding Statement: The authors declared: "None."

Declaration of Interests: The authors stated: "No conflict."

Ethics Approval Statement: The study protocol was approved by the Clinical Research Ethics Committee of the First Affiliated Hospital, Zhejiang University School of Medicine (No. 2011-13). All patients were well informed, and written consent was obtained from the study subjects or the legal surrogates of patients before enrolment.

Keywords: Artificial liver support system; hepatitis B virus-related acute-on-chronic liver failure; case-control matching

Suggested Citation

Yang, Lingling and Wu, Tianzhou and Li, Jiang and Xin, Jiaojiao and Shi, Dongyan and Jiang, Jing and Liang, Xi and Lu, Yingyan and Yao, Heng and Zhang, Huafen and Sun, Suwan and Li, Tan and Hassan Mohamed, Hozeifa Mohamed and Li, Jiaqi and Ren, Keke and Guo, Beibei and Zhou, Xingping and Chen, Jiaxian and Hao, Shaorui and Chen, Jiajia and Xin, Shaojie and Pan, Chen and Han, Tao and Chen, Yongping and Lin, Shumei and Duan, Zhongping and Xu, Xiaowei and Huang, Jianrong and Chen, Xin and Li, Lanjuan and Li, Jun and Group, Chinese Group on the Study of Severe Hepatitis B (COSSH), Artificial Liver Treatment Improves Survival in Patients with Acute-on-Chronic Liver Failure (October 2, 2019). Available at SSRN: https://ssrn.com/abstract=3463300 or http://dx.doi.org/10.2139/ssrn.3463300

Lingling Yang

Zhejiang University - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases

38 Zheda Road
Hangzhou, Zhejiang 310058
China

Tianzhou Wu

Taizhou University

Zhejiang
China

Jiang Li

Zhejiang University - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases

38 Zheda Road
Hangzhou, Zhejiang 310058
China

Jiaojiao Xin

Zhejiang University - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases

38 Zheda Road
Hangzhou, Zhejiang 310058
China

Dongyan Shi

Zhejiang University - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases

38 Zheda Road
Hangzhou, Zhejiang 310058
China

Jing Jiang

Zhejiang University - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases

38 Zheda Road
Hangzhou, Zhejiang 310058
China

Xi Liang

Taizhou University

Zhejiang
China

Yingyan Lu

Tongde Hospital of Zhejiang Province

Hangzhou
China

Heng Yao

Zhejiang University - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases

38 Zheda Road
Hangzhou, Zhejiang 310058
China

Huafen Zhang

Zhejiang University - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases

38 Zheda Road
Hangzhou, Zhejiang 310058
China

Suwan Sun

Zhejiang University - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases

38 Zheda Road
Hangzhou, Zhejiang 310058
China

Tan Li

Zhejiang University - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases

38 Zheda Road
Hangzhou, Zhejiang 310058
China

Hozeifa Mohamed Hassan Mohamed

Zhejiang University - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases

38 Zheda Road
Hangzhou, Zhejiang 310058
China

Jiaqi Li

Zhejiang University - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases

38 Zheda Road
Hangzhou, Zhejiang 310058
China

Keke Ren

Zhejiang University - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases

38 Zheda Road
Hangzhou, Zhejiang 310058
China

Beibei Guo

Zhejiang University - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases

38 Zheda Road
Hangzhou, Zhejiang 310058
China

Xingping Zhou

Zhejiang University - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases

38 Zheda Road
Hangzhou, Zhejiang 310058
China

Jiaxian Chen

Zhejiang University - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases

38 Zheda Road
Hangzhou, Zhejiang 310058
China

Shaorui Hao

Zhejiang University - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases

38 Zheda Road
Hangzhou, Zhejiang 310058
China

Jiajia Chen

Zhejiang University - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases

38 Zheda Road
Hangzhou, Zhejiang 310058
China

Shaojie Xin

Government of the People's Republic of China - People's Liberation Army (PLA)

Beijing
China

Chen Pan

Fujian Medical University - Mengchao Hepatobiliary Hospital

China

Tao Han

Tianjin Third Central Hospital

China

Yongping Chen

Wenzhou Medical University - Department of Infectious and Liver Diseases ( email )

China

Shumei Lin

Xi'an Jiaotong University (XJTU)

26 Xianning W Rd.
Xi'an Jiao Tong University
Xi'an, Shaanxi 710049
China

Zhongping Duan

Capital Medical University

Beijing
China

Xiaowei Xu

Zhejiang University - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases ( email )

38 Zheda Road
Hangzhou, Zhejiang 310058
China

Jianrong Huang

Zhejiang University - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases ( email )

38 Zheda Road
Hangzhou, Zhejiang 310058
China

Xin Chen

Taizhou University ( email )

Zhejiang
China

Lanjuan Li

Zhejiang University - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases ( email )

38 Zheda Road
Hangzhou, Zhejiang 310058
China

Jun Li (Contact Author)

Zhejiang University - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases ( email )

38 Zheda Road
Hangzhou, Zhejiang 310058
China

Zhejiang University - School of Medicine ( email )