Lingling Yang1, Tianzhou Wu2, Jiang Li1, Jiaojiao Xin1,2, Dongyan Shi1,2, Jing Jiang1,2, Xi Liang2, Yingyan Lu3, Heng Yao1, Huafen Zhang1, Suwan Sun1, Tan Li1, Hozeifa Mohamed Hassan Mohamed1, Jiaqi Li1, Keke Ren1, Beibei Guo1, Xingping Zhou1, Jiaxian Chen1, Shaorui Hao1, Jiajia Chen1, Shaojie Xin4, Chen Pan5, Tao Han6, Yongping Chen7, Shumei Lin8, Zhongping Duan9, Xiaowei Xu1, Jianrong Huang1, Xin Chen2,10, Lanjuan Li1, Jun Li1,2. 1. State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China. 2. Precision Medicine Center, Taizhou Central Hospital, Taizhou University Medical School, Taizhou, China. 3. Key laboratory of cancer prevention and therapy combining traditional Chinese and Western Medicine, Tongde Hospital of Zhejiang Province, Hangzhou, China. 4. Department of liver and Infectious Diseases, The Fifth Medical Center of PLA General Hospital, Beijing, China. 5. Department of Liver and Infectious Diseases, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China. 6. Department of Liver and Infectious Diseases, Tianjin Third Central Hospital, Tianjin, China. 7. Department of liver and infectious Diseases, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China. 8. Department of Liver and Infectious Diseases, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China. 9. Department of Liver and Infectious Diseases, Beijing YouAn Hospital, Capital Medical University, Beijing, China. 10. Institute of Pharmaceutical Biotechnology, Zhejiang University School of Medicine, Hangzhou, China.
Abstract
AIM: The artificial liver support system (ALSS) is recognized as a bridge to liver transplantation in hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) patients. However, patient survival remains unknown. We aim to assess the effects of ALSS on survival in HBV-ACLF patients. 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 end-points were cumulative survival rates at days 21, 28, and 90. Four different rigorous analyses were carried out to reduce bias and confounding. RESULTS: 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. These findings were also confirmed through propensity score matching and inverse probability treatment weighting analysis. CONCLUSIONS: ALSS treatment can improve short-term survival and is associated with a significantly lower risk of short-term mortality in patients with HBV-ACLF, especially ACLF-2.
AIM: The artificial liver support system (ALSS) is recognized as a bridge to liver transplantation in hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) patients. However, patient survival remains unknown. We aim to assess the effects of ALSS on survival in HBV-ACLF patients. 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 end-points were cumulative survival rates at days 21, 28, and 90. Four different rigorous analyses were carried out to reduce bias and confounding. RESULTS: 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. These findings were also confirmed through propensity score matching and inverse probability treatment weighting analysis. CONCLUSIONS:ALSS treatment can improve short-term survival and is associated with a significantly lower risk of short-term mortality in patients with HBV-ACLF, especially ACLF-2.