| Background&objectiveLiver failure during pregnancy is an illness that causes serious damage to maternal liver function due to various reasons during pregnancy,with a low incidence,but a high fatality rate,which can endanger the lives of mothers and infants.Artificial liver support system（ALSS）is a kind of extra corporeal liver support for the treatment of liver failure,which has been applied to treat some patients with liver failure in pregnancy.The purpose of this paper goes to explore and analyze the efficacy of ALSS in the treatment of liver failure in pregnancy and the factors related to prognosis,and then screen out those pregnant women who can not benefit from ALSS.MethodsWe searched the cases from January 2008 to September 2019 in the third affiliated Hospital of Guangzhou Medical University,the third affiliated Hospital of Sun Yat-sen University and the eighth people’s Hospital of Guang zhou.The data of100 cases of liver failure during pregnancy in the above three hospitals were screened and collected.Among them,57 cases were treated with ALSS combined with internal medicine,and 43 cases were treated only with internal medicine.According to whether the patients were treated with ALSS or not,the patients were divided into ALSS group and non-ALSS group,and the improvement rate was compared between the two groups,and the curative effect of ALSS was evaluated.Patients were parted into improvement group and ineffective group according to the condition of discharge.Those who meet the discharge criteria are the improvement group,while those who die,give up treatment due to aggravation of the illness or are d ischarged automatically are the ineffective group.The general information of patients,clinical symptoms,laboratory results,liver imaging results,were recorded and analyzed.The short-term prognosis of patients in ALSS group and non-ALSS group were compared,and the factors affecting the prognosis of treatment were analyzed.Results1 Comparison of the effect of ALSS combined with internal medicine and internal medicineIn this study,100 patients were divided into three layers according to INR.The improvement rate of each layer in ALSS group was higher than that in non-ALSS group,but there was no significant difference between the two groups（P>0.05）.2 Prognostic factors of patients with liver failure during pregnancy who treated with ALSSUnivariate analysis showed that the following factors had significant differences between the improvement group and the ineffective group（P<0.05）:Hospitalization days,fatigue,pulmonary edema,splenomegaly,GGTm a x,K+min,APTTmax,LACTmax,NH3max.APTTmax,PTmax,PTAmin and INRmax in the process of ALSS also had significant differences between two group.Multivariate analysis showed that K+min,NH3max,PTAmin（during ALSS）,splenomegaly and pulmonary edema were independent influencing factors for the inefficacy of ALSS tre atment,among which K+min,NH3max,pulmonary edema were independent risk factors.We can establish the following combined model:Logit（Pinefficacy）=2.692XK+min+0.029XNH3max-0.162XPTAmin-3.851Xspleno-m e g a l y+2.93Xpulmonaryedema-8.899（Nagelkerke R2=0.735）,AU C=0.940（P<0.05）,Kappa value=0.675（P<0.05）.The cutoff value of K+min is 3.29 and the cutoff value of NH3max is 87.4.Conclusion（1）The improvement rate of ALSS combined with medical comprehensive treatment was greater than of medical comprehensiv e treatment,but the difference was not statistically significant（P>0.05）.（2）Multivariate analysis showed that K+min,NH3max,splenomegaly and were independent risk factors for the inefficacy of ALSS treatment.When K+min>3.29mmol,NH3max>87.4umol/L,the risk of ineffectiv e ALSS treatment was greatly increased.The combined model Logit(Pineffica c y)=2.692XK+min+0.029XNH3max-0.162XPTAmin-3.851Xsplenomegaly+2.93Xpulmonary e d e m a-8.899,（Nagelkerke R2=0.735）can be used to predict patients who a-re ineffective after ALSS treatment,and its predictive ability（AUC=0.940）and consistency intensity（Kappa value=0.675）are high. |
