Analysis Of Influencing Factors Of Short-Term Prognosis In Patients With Liver Failure Treated By Plasma Exchange

Objective:1.To investigate the influencing factors of plasma exchange(PE)in patients with liver failure for 3 months.2.To investigate the relationship between total bilirubin clearance(TBCR)and bilirubin rebound rate(TBRR)and short-term prognosis in plasma exchange(PE)for patients with chronic acute liver failure(ACLF)and the influencing factors of TBRR.Methods:The clinical data of patients with liver failure who underwent PE treatment from 2015 to 2018 were collected.A total of 84 patients met the inclusion criteria.The changes of laboratory indexes before and after PE treatment were observed and the patients were followed up.The COX proportional hazards regression model was used to analyze the influencing factors of PE in the treatment of patients with liver failure at 3 months.Among them,59 patients with ACLF were divided into survival group and death group according to the survival status from admission to January.The t test was used to compare whether the TBCR and TBRR levels were different between the two groups.The receiver operating characteristic(ROC)curve was used to evaluate the value of TBRR and TBCR in the short-term prognosis of patients,and multiple linear regression analysis was used to analyze the influencing factors of TBRR.Results:1.Comparison of biochemical indicators and MELD scores before and afterPE treatmentAfter PE treatment,liver function and blood coagulation improved significantly.MELD score,TBiL,ALT,AST,INR and PT were lower than before treatment.ALB and PTA were higher than before treatment,p<0.01.In blood cell analysis,HGB,RBC,and PLT were lower than before treatment,p<0.01.2.Analysis of 3 months survival time of 84 patients with liver failureA total of 84 patients were observed.During the observation period(90 days),a total of 42 patients died and the median survival time was 50 days(95% CI was 17 days to 82 days).3.COX regression analysis of 3 months prognosis of patients with liver failure treated with PEThe factors affecting the 3-month survival time of patients with liver failure may be age,hepatic encephalopathy,PE treatment times,ALT,TBiL,PTA,INR,CR,WBC,MELD scores(p<0.20).After excluding factors that may cause multiple collinearity,the remaining factors were analyzed by multivariate gradual COX regression model.The results showed that age,ALT,TBiL,INR,WBC,etc.increased the risk of death for 3 months(p<0.05),the HR values were 1.046,1.001,1.004,1.641,1.107,respectively.The number of PE treatments was a protective factor for reducing mortality(p<0.05),and the HR value was 0.675.4.Relationship between changes in TBiL and short-term efficacy in patients with ACLF treated with PEThere was no significant difference in TBCR between the 4-week improvement group and the worsening group in PE-treated patients with ACLF,but there was a significant difference in TBRR.The TBRR values of the two groups were22.25±20.84)%、(49.82±23.37)%,p<0.05.5.The value of TBRR in the short-term prognosis of PE patients with ACLF is higher than that of TBCR.The AUC of TBRR was 0.817,the sensitivity was 82.6%,the specificity was 69.4%,the Yoden index was 0.52,and the AUC of TBCR was0.623(p>0.05).6.Multivariate linear regression analysis of TBRR in patients with ACLFtreated with PEThe results showed that both disease stage and age were the influencing factors of TBRR.Disease stage is most closely related to TBRR.7.Statistics of adverse reactions in 59 patients with ACLF treated with PE59 patients underwent PE treatment for 178 times,and the incidence of adverse reactions was 16.8%.The main adverse reactions were perioral numbness(10 cases),hand and foot numbness(6 cases),mild irritability(1 case),nausea and vomiting(2cases).Abdominal pain(1 case),general malaise(1 case),transient blood pressure drop(1 case).Symptoms are relieved after symptomatic treatment such as calcium supplementation and antiemetic,which does not affect PE treatment.Conclusion:1.PE is effective in the treatment of liver failure.Early detection,early treatment and early prevention and treatment of infection can significantly improve the prognosis of patients with liver failure.2.TBRR can be used as a simple method to predict the short-term efficacy of patients with ACLF.The higher the TBRR,the worse the short-term prognosis of patients.The severity of the disease affects the level of TBRR.