Clinical efficacy of double plasma molecular absorption system and sequential plasma exchange combined with continuous renal replacement therapy in treatment of acute-on-chronic liver failure with acute kidney injury / 临床肝胆病杂志

ObjectiveTo investigate the clinical efficacy of double plasma molecular adsorption system （DPMAS） and sequential plasma exchange （PE） combined with continuous renal replacement therapy （CRRT） in the treatment of patients with acute-on-chronic liver failure （ACLF） and acute kidney injury （AKI）. MethodsA retrospective analysis was performed for the clinical data of 90 patients with ACLF and AKI who were hospitalized in The Affiliated Hospital of Guizhou Medical University from January 2019 to December 2022， and according to the method for blood purification， they were divided into DPMAS sequential PE+CRRT group （observation group with 31 patients） and DPMAS sequential PE group （control group with 59 patients）. General data on admission and laboratory markers before and after blood purification were collected from all patients， including hepatic and renal function， coagulation function， and inflammation markers， and estimated glomerular filtration rate （eGFR） and MELD combined with serum sodium concentration （MELD-Na） score were calculated. The independent-samples t test was used for comparison of normally distributed continuous data between two groups； the Wilcoxon rank sum test was used for comparison of non-normally distributed continuous data within each group before and after treatment， and the Mann-Whitney U test was used for comparison between two groups； the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups. ResultsThe observation group had a significantly higher response rate than the control group ［48.4% （15/31） vs 27.1% （16/59）， χ2=4.071， P=0.044］. The methods for blood purification in both groups could effectively improve total bilirubin， alanine aminotransferase， aspartate aminotransferase （AST）， prothrombin time activity， serum creatinine （Scr）， procalcitonin （PCT）， C-reactive protein， eGFR， and MELD-Na score （all P<0.05）， and both groups had significant reductions in platelet count （PLT） and hemoglobin （Hb） after treatment （all P<0.05）， while there were no significant changes in blood urea nitrogen， albumin， and international normalized ratio after treatment （all P>0.05）. There were significant differences between the two groups in the changes in AST， Scr， PCT， eGFR， MELD-Na score， Hb， and PLT after treatment （all P<0.05）. ConclusionDPMAS sequential PE combined with CRRT can effectively remove inflammatory mediators， improve renal function， stabilize the internal environment of human body， and achieve a relatively good clinical efficacy.

Effect and safety of double plasma molecular absorption in treatment of patients with severe wasp stings injury: a multicenter historical cohort study / 中华危重病急救医学

Objective:To compare the effect and safety of continuous veno-venous hemofiltration (CVVH)+double plasma molecular absorption (DPMA)+hemoperfusion (HP), CVVH+HP, and CVVH+plasma exchange (PE) in treatment of patient with severe wasp stings injury.Methods:Multicenter, historical cohort study and superiority test were used. From July 2020 to October 2022, patients with wasp sting injury and multiple organ damage admitted to the intensive care units (ICU) of five hospitals were consecutively screened and recruited into the CVVH+DPMA+HP group (intervention group). Propensity score matching was used to establish historical cohorts. Patients with severe wasp sting injury who hospitalized from January 2016 to June 2020 in each ICU were collected and matched 1∶1 with the intervention group, and divided into CVVH+HP group and CVVH+PE group according to their actual hemopurification protocols (historical control groups). The primary outcome was the acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score on days 3 and 7 after initiation of treatment. Secondary outcomes included complications, length of ICU and hospital stays, and all-cause mortality. Multivariate Cox proportional risk regression was used to analyze the prognosis of patients.Results:After propensity score matching, 56 patients in intervention group and each of the two historical control groups were matched successfully. There were no significant differences in age, gender, comorbidities, biochemical test indices and critical illness scores among the groups. After treatment, APACHE Ⅱ score markedly declined in all groups, and the decrease was faster in the intervention group; treatment with DPMA [hazard ratio ( HR) = 1.04, 95% confidence interval (95% CI) was 1.02-1.08, P = 0.00], the decreased levels of body temperature ( HR = 1.02, 95% CI was 1.00-1.03, P = 0.02), serum creatine kinase (CK; HR = 0.98, 95% CI was 0.96-1.00, P = 0.05) and myoglobin (MYO; HR = 2.88, 95% CI was 1.24-6.69, P = 0.01) were independent risk factors for APACHE Ⅱ score decline to the target value (15 scores). There were no significant differences in the incidence of bleeding complications, filter or perfusion thrombosis, blood pressure reduction, catheter-related infection and anaphylaxis among the groups. Conclusion:CVVH+DPMA+HP regimen can significantly reduce the APACHE Ⅱ score of patients with severe wasp sting injury, and the efficacy is superior to CVVH+HP and CVVH+PE regimens, with safety.

Clinical study of combined blood purification therapy for patients with multiple organ dysfunction syndrome complicated with liver failure / 中华急诊医学杂志

Objective To explore the clinical efficacy of artificial liver technique - double plasma molecular adsorption(DPMAS) combined with continuous renal replacement therapy(CRRT) in the treatment of multiple organ dysfunction syndrome(MODS) patients with liver failure. Methods From April 2014 to October 2016, in the Qinghai Provincial People's Hospital emergency ICU hospitalized MODS combined with liver failure patients were enrolled in this study. On the basis of comprehensive medical treatment, these patients were randomly(random number) divided into CRRT control group(23 cases) and DPMAS + CRRT treatment group(22 cases). Blood biochemical, coagulation index, inflammatory factor and severity score of two groups were comparied before and 72 h after treatment. Results The levels of alanine aminotransferase(ALT), aspartate aminotransferase(AST), blood amine(NH3), creatinine(CREA), interleukin-6(IL-6), tumor necrosis factor-α(TNF-α), heart rate(HR),APACHE Ⅱ score and SOFA score in CRRT control group were statistically different before and after treatment (P<0.01). However, there was no significant difference in the levels of total bilirubin(TBIL), direct bilirubin(DBIL), bile acid(TBA), prothrombin activity(PTA) and international standardized ratio(INR) (P> 0.05); In the DPMAS + CRRT treatment group, the levels of ALT, AST, NH3, CREA, IL-6, TNF-α, HR, APACHEⅡand SOFA scores were significantly different before and after treatment (P<0.01), as well as the levels of DBIL, TBA, PTA, INR(P<0.01). There was significant differences in ALT, AST, TBIL, DBIL, TBA PTA, INR, IL-6, TNF-α, APACHE Ⅱ and SOFA scores between the two groups (P<0.05), while the levels of CREA, NH3, MAP, HR of these two groups had no significant difference (P>0.05). Conclusions Because of the combination of double plasma adsorption, besides the advantages of CRRT, DPMAS+CRRT can remove bilirubin and bile acid which can not be removed by CRRT, also improve coagulation function. The clearance efficiency of inflammatory factors is also higher, and the severity score is reduced more significantly.