摘要
BACKGROUND We have innovatively amalgamated membrane blood purification and centrifugal blood cell separation technologies to address the limitations of current artificial liver support(ALS)models,and develop a versatile plasma purification system(VPPS)through centrifugal plasma separation.AIM To investigate the influence of VPPS on long-term rehospitalization and mortality rates among patients with acute-on-chronic liver failure(ACLF).METHODS This real-world,prospective study recruited inpatients diagnosed with ACLF from the Second Xiangya Hospital of Central South University between October 2021 and March 2024.Patients were categorized into the VPPS and non-VPPS groups based on the distinct ALS models administered to them.Self-administered questionnaires,clinical records,and self-reported data served as the primary methods for data collection.The laboratory results were evaluated at six distinct time points.All patients were subjected to follow-up assessments for>12 months.Kaplan-Meier survival analyses and Cox proportional hazards models were used to evaluate the risks of hospitalization and mortality during the follow-up period.RESULTS A cohort of 502 patients diagnosed with ACLF was recruited,with 260 assigned to the VPPS group.On comparing baseline characteristics,the VPPS group exhibited a significantly shorter length of stay,higher incidence of spontaneous peritonitis and pulmonary aspergillosis compared to the non-VPPS group(P<0.05).Agehazard ratio(HR=1.142,95%CI:1.01-1.23,P=0.018),peritonitis(HR=2.825,95%CI:1.07-6.382,P=0.026),albumin(HR=0.67,95%CI:0.46-0.942,P=0.023),total bilirubin(HR=1.26,95%CI:1.01-3.25,P=0.021),international normalized ratio(HR=1.97,95%CI:1.21-2.908,P=0.014),and VPPS/non-VPPS(HR=3.24,95%CI:2.152-4.76,P<0.001)were identified as significant independent predictors of mortality in both univariate and multivariate analyses throughout the follow-up period.Kaplan-Meier survival analyses demonstrated significantly higher rehospitalization and mortality rates in the non-VPPS group compared to the VPPS group during follow-up of≥2 years(log-rank test,P<0.001).CONCLUSION These findings suggest that VPPS is safe and has a positive influence on prognostic outcomes in patients with ACLF.
基金
Supported by Natural Science Foundation of Hunan Province,China,No.2022JJ30842 and No.2024JJ6560
Clinical Medical Research Center for Viral Hepatitis of Hunan Province,No.2023SK4009
Beijing iGandan Foundation,No.RGGJJ-2021-017 and No.iGandanF-1082022-RGG023.
