| Background:Liver failure is a serious liver damage induced by a variety of causes.It leads to severe disorders or decompensation of liver synthesis,detoxification,metabolism and biotransformation.Liver failure constitutes a group of clinical symptoms mainly manifested by jaundice,coagulation function disorders,hepatorenal syndrome,hepatic encephalopathy(HE),and ascites.The pathogenesis of liver failure is very complicated.The current research shows that liver failure mainly involves a large number of liver cell deaths and insufficient regeneration capacity,direct damage to liver cells caused by viruses,drugs,alcohol,etc.,immune-mediated indirect damage,inflammation,ischemia and hypoxia damage as well as endotoxemia,which cause organ tissue structure and function disorder.5-Hydroxytryptamine 3 receptor antagonists(5-HT3RAs)were widely used to prevent and treat nausea and vomiting caused by cancer chemotherapy,radiotherapy,anesthesia,and post-operation.Furthermore,anti-oxidation,anti-inflammatory and immunomodulatory properties have been observed for 5-HT3 RAs.Many studies have observed that 5-HT3 RAs can reduce liver damage caused by various causes in animal models.The diagnosis and treatment of liver failure has always been a hot and difficult point in clinical practice.The medical treatment of liver failure lacks effective drugs and methods.However,whether 5-HT3 RAs may affect the prognosis of patients with liver failure is unclear.Objective:To investigate whether treatment with 5-HT3 RAs may affect the prognosis of patients with liver failure in order to provide new idea and evidence for the clinical treatment of liver failure.Method:This retrospective study collected data of demographic,clinical,treatment,and laboratory parameters of patients diagnosed with liver failure in the First Affiliated Hospital of Xi’an Jiaotong University from May,2013 to June,2019.According to whether 5-HT3 RAs were used or not,the patients were divided into 5-HT3 RAs group and control group.Cox proportional hazards regression model was used to assess the impact of all baseline covariates on the outcome.In the regression model,hazard ratio(HR)and its 95 %confidence intervals(CI)were used to describe each variable.Propensity score matching(PSM)was used to repeat the analysis of the cohort.Inverse probability treatment weighting(IPTW)was also used.PSM and IPTW were performed by using Empower Stats2.0 software,and the other statistical analysis was carried out by using SPSS 25.0statistical software.According to the test level of α = 0.05,P<0.05 was considered as statistically significant.Results:A total of 419 patients with liver failure [46 acute(ALF),93 sub-acute(SALF),44chronic(CLF),and 236 acute on chronic(ACLF)] were included in this study.The patients were divided into 5-HT3 RA group(n=105)and control group(n=314)according to whether 5-HT3 RAs were used or not.5-HT3 RAs were significantly associated with decreased 28-day(HR 0.18,95% CI 0.10-0.34,P<0.001)and 90-day(HR 0.21,95% CI0.13-0.33,P<0.001)mortality.After PSM(n=134,n=67 in each group),5-HT3 RAs were still significantly associated with reduced 28-day(HR 0.10,95%CI 0.04-0.26,P<0.001)and 90-day(HR 0.16,95%CI 0.08-0.31,P<0.001)mortality.5-HT3 RA group patients had significantly higher 28-day and 90-day survivals than controls both before(28-day: 88.6%vs.66.6%;90-day: 78.1% vs.48.8%,both P<0.001)and after(28-day,91.0% vs.56.7%;90-day,80.6% vs.44.8%,both P<0.001)PSM.Subgroup analysis showed significantly higher 28-day and 90-day survivals in 5-HT3 RA groups of SALF and ACLF,and hepatitis B virus(HBV)-related liver failure patients than in the corresponding controls.Conclusion:Our study suggests that 5-HT3 RAs are associated with increased short-term survivals of patients with liver failure,with SALF and ACLF,and HBV-related liver failure in particular. |
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