| ObjectiveIn this study,we aimed to explore the factors affecting the short-term efficacy of plasma exchange related abiotic artificial liver in the treatment of acute(subacute)-on-chronic liver failure,and the cost-effectiveness ratio of plasma exchange related abiotic artificial liver in the treatment of acute(subacute)-on-chronic liver failure in the early,middle and late stages,to provide the clinical basis for the rational use of artificial liver.MethodsWe counted the clinical data of patients with acute(subacute)-on-chronic liver failure and treated with non-biological artificial liver plasmapheresis from January 2014 to July 2019.We used univariate analysis and binomial logistic regression to analyze the influencing factors of plasma exchange related abiotic artificial liver in treatment of acute(subacute)-on-chronic liver failure,and compare the efficacy andcost-effectiveness ratio of plasma exchange related abiotic artificial liver therapy in different stages of acute(subacute)-on-chronic liver failure,compared the frequency and efficacy of plasma exchange-related non-biological artificial liver.ResultsBilirubin and the staging of liver failure were independent factors affecting the short-term efficacy of plasma exchange-related abiotic artificial liver in treating acute(subacute)-on-chronic liver failure.There were statistical differences in the staging of acute(subacute)-on-chronic liver failure and the number of plasma exchange-related abiotic artificial liver(P<0.05);In the early stage,the average number of artificial livers was 1.35 times,with an improvement rate of 75.80%,and the average cost of 26,800 yuan could improve one patient;In the middle stage,there was an average of 1.74 times,with an improvement rate of 37.10%,and the average cost of 70,400 yuan could improve one patient;In the late stage,there was an average of 2.13 times,with an improvement rate of 2.50%,and the average cost of 1230,000 yuan could improve one patient.The average daily cost of patients with acute(subacute)-on-chronic liver failure in different stages was statistically different(P<0.05);the average daily cost of the patients in the early stage was 3894.53 yuan,that was 5593.52 yuan in the intermediate stage and 10128.82 yuan in the advanced stage.The short-term efficacy of plasma exchange-related abiotic artificial liverin the treatment of acute(subacute)-on-chronic liver failure showed statistical difference in age between the two groups(P<0.05);the mean age of the improvement group was 43.88 years old,and that of the invalid group was 48.13 years old;high age levels may suggest poor short-term prognosis for acute(subacute)-on-chronic liver failure with plasma exchange associated abiotic artificial liver.There were statistically significant gender differences in the short-term efficacy of plasma exchange-related abiotic artificial liver for acute(subacute)-on-chronic liver failure(P<0.05);the improvement rate of male patients was 38.46% higher than that of female patients was 20.51%,this may be associated with significant differences in early-to-late stage composition(28.85%,39.42%,31.73% vs 5.13%,58.97%,35.90%)and age(45.91 years vs 51.69 years)between male and female patients(P<0.05).The number of artificial liver treatments and the treatment efficiency were statistically significant(P<0.05),the recovery rate of patients treated with artificial liver for more than 3 times was significantly reduced.ConclusionBilirubin and liver failure stage are independent factors influencing the short-term efficacy of plasma exchange-related abiotic artificial liver for acute(subacute)-on-chronic liver failure.Patients with acute(subacute)-on-chronic should be treated with abiotic artificial liver as soon as possible.For patients without liver transplantation plan,if liver failure progressed toadvanced stage or abiotic artificial liver was used more than 3 times,continuous abiotic artificial liverr treatment has low benefit.At the same time,the importance of early diagnosis and treatment of chronic acute(subacute)liver failure still needs to strengthen education and publicity;more attention should be paid to elderly patients with liver failure. |
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