ABSTRACT Acute‐on‐chronic liver failure (ACLF) is the most prevalent type of liver failure in Asia, with hepatitis B virus (HBV) infection being the primary cause in our country. This study aimed to evaluate the effectiveness of the artificial liver support system (ALSS) in treating HBV‐induced ACLF (HBV‐ACLF) and assess the efficacy and safety of a combined ALSS model with small‐volume plasma. A retrospective analysis compared the 4‐week and 12‐week survival rates of patients receiving comprehensive medical treatment versus ALSS treatment and identified factors associated with mortality. Patients undergoing the combined ALSS model (plasma exchange + double plasma adsorption system/hemoperfusion, PE + DPMAS/HP) were categorized into small‐volume plasma and half‐volume plasma groups. Changes in liver function, renal function, coagulation function, and blood ammonia levels following PE + DPMAS/HP treatment were analyzed. Mortality rates at 4 and 12 weeks were compared between the two groups, and factors influencing 4‐week and 12‐week mortality in HBV‐ACLF patients were examined. The results indicated no significant difference in 4‐week mortality between the ALSS and medical treatment groups; however, the ALSS group showed a significantly improved 12‐week survival rate. Both small‐volume and half‐volume plasma ALSS models effectively eliminated bilirubin, bile acids, urea, and creatinine. No significant differences were observed in 4‐week and 12‐week mortality between the small‐volume and half‐volume plasma groups, regardless of the severity of HBV‐ACLF (early, middle, or late stages). COX proportional hazard regression analysis revealed that the amount of plasma used in ALSS treatment was not a significant factor influencing HBV‐ACLF prognosis. The combined ALSS model with reduced plasma usage may help alleviate the limited plasma supply and merits further application and promotion.
Li et al. (Sun,) studied this question.