Therapeutic Effects Of Non-biological Artificial Liver On Drug-induced Liver Injury

Objectives:The incidence of drug-induced liver injury(DILI)has been increasing in recent years.DILI often leads to a variety of serious clinical outcomes including liver failure.When liver failure occurs,liver transplantation(LT)is often required to save patients’ lives,but it is limited by the shortage of donor livers.The effects of artificial liver support system(ALSS)in the treatment of various liver diseases has been affirmed in recent years,but there are few studies in DILI.This study used retrospective analysis to compare the clinical indicators of DILI patients before and after treatment with non-biological artificial liver(NBAL),to verify the effectiveness of NBAL in the treatment of DLIL,to compare the differences in the efficacy of different artificial liver treatment modes(DPMAS,PE and DPMAS+PE)in the treatment of DILI,to evaluate the effect of liver failure on the curative effect of artificial liver treatment in DILI patients,and further explore the influencing factors of the curative effect of artificial liver treatment in DILI patients.Methods:The data of 91 patients with DILI who underwent NBAL treatment in the Gastroenterology Department of the Second Affiliated Hospital of Kunming Medical University from August 2015 to December 2020 were retrospectively collected.According to the different treatment modes of artificial liver,they were divided into DPMAS group(50 cases),PE group(21 cases)and DPMAS+PE group(20 cases).The following information was collected:1)General information:age,gender,past medical history,medication history,and time from medication to onset;2)Laboratory examination:white blood cell(WBC),hemoglobin(HGB),albumin(ALB),alanine aminotransferase(ALT),aspartate aminotransferase(AST),alkaline phosphatase(ALP),gamma-glutamyl transferase(GGT),total bilirubin(TBIL),direct bilirubin(DBIL),creatinine(CR),serum potassium(K),serum sodium(Na),prothrombin time(PT),international normalised ratio(INR),activated partial thromboplastin time(APTT),prothrombin activity(PTA),procalcitonin(PCT),high-sensitivity C-reactive protein(hs-CRP)before and immediately after artificial liver treatment;3)The modes and frequency of artificial liver treatment.The following comparison was performed:1)General information of the three groups of patients;2)Blood routine,liver function test,renal function test,electrolytes,coagulation function and inflammatory mediators of the three groups before and after artificial liver treatment;3)The decline rate of various indicators after artificial liver treatment in the three groups;4)The decline rate of various indicators after artificial liver treatment in patients with and without liver failure;5)The indicators of effective treatment and not effective treatment in patients with liver failure,and the indicators of effective treatment and significantly effective treatment in patients without liver failure.Results:1)There was no statistically significant difference in the general information of the three groups of patients(all P>0.05);2)The levels of liver enzymes(ALT,AST,ALP and GGT),bilirubin(TBIL and DBIL),HGB and ALB levels of the three groups were significantly lower after artificial liver treatment(all P<0.05),and no significant increase or decrease in electrolytes(both potassium and sodium)was observed(P>0.05);3)CR,PCT and hs-CRP were significantly decreased after treatment in DPMAS and DPMAS+PE groups,while PT decreased and PTA increased significantly after treatment in PE and DPMAS+PE groups(all P<0.05);4)The decline rates of liver enzymes and bilirubin were not significantly different among the three groups(P>0.05);the decline rates of CR,PCT and hs-CRP in DPMAS and DPMAS+PE groups were higher than those in PE group,and the decline rates of PT and the increase rate of PTA in PE and DPMAS+PE groups were higher than those in DPMAS group(all P<0.05);5)The decline rate of TBIL and DBIL in patients with liver failure were lower than those of patients without liver failure(P<0.05);6)In patients without liver failure,the number of artificial liver treatments and the levels of ALT and TBIL before treatment in the significantly effective treatment group were higher than those in the effective treatment group(all P values<0.05);in patients with liver failure,the levels of TBIL,PT and INR before treatment in the ineffective treatment group were higher than those in the effective treatment group(all P values<0.05).Conclusions:1)DPMAS,PE and DPMAS+PE can significantly improve the liver function of patients with DILI,but also cause the loss of hemoglobin and albumin;2)DPMAS is better than PE in removing creatinine and inflammatory mediators,and PE is better than DPMAS in improving coagulation function.The combination of the two can make up for their respective deficiencies;3)Liver failure will affect the efficacy of artificial liver treatment in patients with DILI;4)The number of artificial liver treatments,ALT and TBIL levels before treatment are the influencing factors for the therapeutic effect of artificial liver in DILI patients without liver failure,and the levels of TBIL,PT and INR before treatment are influencing factors for the therapeutic effect of artificial liver treatment in DILI patients with liver failure.