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BACKGROUND:Plasma exchange(PE)-centered artificial liver support system reduced the high mortality rate of hepatitis B virus(HBV)-related acute-on-chronic liver failure(ACLF).But the data were diverse in different medical centers.The present prospective nationwide study was to evaluate the effects of PE on patients with HBV-ACLF at different stages.METHODS:From December 2009 to December 2011,we evaluated 250 patients at different stages of HBV-ACLF from 10 major medical centers in China.All the laboratory parameters were collected at admission,before and after PE.RESULTS:Among the 250 patients who underwent 661 rounds of PE,one-month survival rate was 61.6%; 141(56.4%) showed improvement after PE.Variables such as age(P=0.000),levels of total bilirubin(TB,P=0.000),direct bilirubin(P=0.000),total triglycerides(P=0.000),low-density lipoprotein(P=0.022),Na+(P=0.014),Cl–(P=0.038),creatinine(Cr,P=0.007),fibrinogen(P=0.000),prothrombin time(PT,P=0.000),white blood cell(P=0.000),platelet(P=0.003) and MELD(P=0.000) were significantly related to prognosis.Multivariate logistic regression analysis showed that age,disease stage,TB,Cr and PT levels were independent risk factors of mortality among HBV-ACLF patients.CONCLUSIONS:PE can improve the clinical outcome of patients with HBV-ACLF.Levels of TB,Cr and PT,age and disease stage help to predict prognosis.
BACKGROUND: Plasma exchange (PE) -centered artificial liver support system reduced the high mortality rate of hepatitis B virus (HBV) -related acute-on-chronic liver failure (ACLF) .But the data were diverse among different medical centers. Present prospective nationwide study was to evaluate the effects of PE on patients with HBV-ACLF at different stages. METHODS: From December 2009 to December 2011, we evaluated 250 patients at different stages of HBV-ACLF from 10 major medical centers in China. All the laboratory parameters were collected at admission, before and after PE .RESULTS: Among the 250 patients who underwent 661 rounds of PE, one-month survival rate was 61.6%; 141 (56.4%) showed improvement after PE. Variables such as age (P = 0.000), levels of total bilirubin (P = 0.000), direct bilirubin (P = 0.000), total triglycerides (P = 0.000), low-density lipoprotein (P = 0.038), creatinine (Cr = 0.007), fibrinogen (P = 0.000), prothrombin time (PT, P = 0.000) 0.003) and MELD (P = 0.000) were significantly related to prognosis. Multivariate logistic regression analysis showed that age, disease stage, TB, Cr and PT levels were independent risk factors of immigrating HBV-ACLF patients. CONCLUSIONS: PE can improve the clinical outcome of patients with HBV-ACLF. Levels of TB, Cr and PT, age and disease stage help to predict prognosis.