Efficacy Of Single Plasma Exchange Versus Plasma Exchange Combined With Adsorption In Children With Acute Liver Failure

Background:Pediatric acute liver failure(PALF)is a severe liver damage caused by multiple etiologies.The etiology is complex,the disease progresses rapidly,the treatment is difficult and the mortality rate is high.Artificial liver is one of the most common methods for the treatment of children with acute liver failure.The non-biological artificial liver removes harmful metabolites and supplies necessary ingredients by dialysis,filtration,replacement,adsorption and other methods,so as to buy time for the regeneration of liver or liver transplantation.Non-biological artificial livers include a variety of different models,there are still a lack of reports on which model is more suitable for children with acute liver failure.Objective:To compare the efficacy of pure plasma exchange and plasma exchange combined with double plasma molecule adsorption,two different non-biological liver models,in children with acute liver failure.Methods:Children with acute liver failure who were admitted to pediatric intensive care unit(PICU)in 13 hospitals in Shandong Province from January 2010 to July 2021 were retrospectively collected,and children with ALF who received plasma exchange alone or plasma exchange combined with double adsorption molecule adsorption therapy were included.Included patients were divided into pure plasma exchange group and plasma exchange combined with adsorption group according to the mode of the artificial liver.The 28-day mortality rate,the effective rate after artificial liver treatment,the incidence of adverse events during treatment,the amount of plasma used,the rate of decline in Pediatric Sequential Organ Dysfunction Score(PSOFA)and the Model for End-Stage Liver Disease(PELD)score and other laboratory indicators after 72 hours of artificial liver treatment were compared between the two groups.Results:(1)A total of 58 children with acute liver failure were included,including 33 males with a median age of 25 months.There were 40 cases in the plasma exchange group and 18 cases in the plasma exchange combined with adsorption group.There were no significant differences in age,gender,weight,body mass index,laboratory indicators such as liver function,coagulation function,and renal function before artificial liver treatment,as well as PSOFA and PELD scores between the two groups(p>0.05).(2)After 72 hours of artificial liver treatment,the levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL)and direct bilirubin(DBIL)in the two groups were significantly lower than those before treatment(p<0.05),and the levels of international normalized ratio(INR)and prothrombin time activity(PTA)were also improved compared with those before treatment(p<0.05).The PELD score was significantly lower than that before treatment(p<0.05).(3)After 72 hours of artificial liver treatment,compared with the pure plasma exchange group,the rates of decline in total bilirubin,interleukin-6 and blood ammonia in the plasma exchange combined with adsorption group were higher(65.4%vs 28.6%,81.0%vs 22.2%,29.8%vs 11.4%,p<0.05),and PSOFA and PELD scores had a higher rate of decline(20.0%vs 0%,67.4%vs 34.7%,p<0.05).(4)After the treatment of artificial liver treatment,the effective rate of plasma exchange combined with adsorption group was significantly higher than that of plasma exchange group(77.8%vs 45.0%,p<0.05).(5)Compared with the pure plasma exchange group,the plasma exchange combined with adsorption group required less plasma,which was about half of the pure plasma exchange group(28 ml/kg vs 52 ml/kg,p<0.05).(6)Compared with the pure plasma exchange group,the incidence of adverse events during plasma exchange combined with adsorption therapy was lower(p<0.05).A total of 8 adverse events occurred in the pure plasma exchange group,including hypotension(n=4),allergic reaction(n=3),and hypercalcemia(n=1).No adverse event occurred in the plasma exchange combined with adsorption group.(7)The 28-day mortality rate of plasma exchange combined with adsorption group was 22.2%,and the plasma exchange alone group was 30.0%,there was no statistical difference(p>0.05).(8)The two groups showed no significant differences in the duration of vasoactive drugs use,PICU charge and PICU staying time(p>0.05).Conclusions:Compared with plasma exchange alone,plasma exchange combined with double plasma molecular adsorption cannot decrease the 28-day mortality of children with acute liver failure,but it improve the short-term treatment efficiency and has a lower incidence of adverse events as well as save the amount of plasma required for treatment.