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CN 22-1108/R
Volume 40 Issue 3
Mar.  2024
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Article Navigation >  Journal of Clinical Hepatology  > 2024  >  40(3): 556-561

Clinical efficacy of double plasma molecular absorption system and sequential plasma exchange combined with continuous renal replacement therapy in treatment of acute-on-chronic liver failure with acute kidney injury

DOI: 10.12449/JCH240319

  • Department of Infectious Diseases，The Affiliated Hospital of Guizhou Medical University，Guizhou 550002，China

Research funding:

Beijing Liver and Gall Blessing Foundation Artificial Liver Special Fund Project (RGGJJ-2021-001);

Fundamental Research Project of Guizhou Provincial Science and Technology Department（Qiankehe Foundation-ZK［2022］ General 452） 

More Information
  • Corresponding author: ZHU Juanjuan， 184184239@qq.com （ORCID： 0000-0003-0692-9200）
  • Received Date: 2023-06-10
  • Accepted Date: 2023-07-24
  • Published Date: 2024-03-20
    Abstract
  •   Objective  To investigate the clinical efficacy of double plasma molecular adsorption system （DPMAS） and sequential plasma exchange （PE） combined with continuous renal replacement therapy （CRRT） in the treatment of patients with acute-on-chronic liver failure （ACLF） and acute kidney injury （AKI）.  Methods  A retrospective analysis was performed for the clinical data of 90 patients with ACLF and AKI who were hospitalized in The Affiliated Hospital of Guizhou Medical University from January 2019 to December 2022， and according to the method for blood purification， they were divided into DPMAS sequential PE+CRRT group （observation group with 31 patients） and DPMAS sequential PE group （control group with 59 patients）. General data on admission and laboratory markers before and after blood purification were collected from all patients， including hepatic and renal function， coagulation function， and inflammation markers， and estimated glomerular filtration rate （eGFR） and MELD combined with serum sodium concentration （MELD-Na） score were calculated. The independent-samples t test was used for comparison of normally distributed continuous data between two groups； the Wilcoxon rank sum test was used for comparison of non-normally distributed continuous data within each group before and after treatment， and the Mann-Whitney U test was used for comparison between two groups； the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups.  Results  The observation group had a significantly higher response rate than the control group ［48.4% （15/31） vs 27.1% （16/59）， χ2=4.071， P=0.044］. The methods for blood purification in both groups could effectively improve total bilirubin， alanine aminotransferase， aspartate aminotransferase （AST）， prothrombin time activity， serum creatinine （Scr）， procalcitonin （PCT）， C-reactive protein， eGFR， and MELD-Na score （all P<0.05）， and both groups had significant reductions in platelet count （PLT） and hemoglobin （Hb） after treatment （all P<0.05）， while there were no significant changes in blood urea nitrogen， albumin， and international normalized ratio after treatment （all P>0.05）. There were significant differences between the two groups in the changes in AST， Scr， PCT， eGFR， MELD-Na score， Hb， and PLT after treatment （all P<0.05）.  Conclusion  DPMAS sequential PE combined with CRRT can effectively remove inflammatory mediators， improve renal function， stabilize the internal environment of human body， and achieve a relatively good clinical efficacy.

     

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