Effect of artificial liver support therapy on the short-term prognosis of patients with liver failure in the plateau stage: A stratified analysis based on Model for End-Stage Liver Disease score / 临床肝胆病杂志

ABSTRACT

ObjectiveTo investigate the effect of artificial liver support therapy on the short-term (28- and 90-day) mortality rate of patients with liver failure in the plateau stage through a stratified analysis based on Model for End-Stage Liver Disease (MELD) score. MethodsA retrospective analysis was performed for 187 patients with liver failure who were admitted to Nanfang Hospital, Southern Medical University, from January 2015 to April 2019, with 73 patients in the artificial liver group and 114 in the non-artificial liver group. The stratified analysis based on MELD score in the plateau stage was performed to investigate the differences in 28- and 90-day mortality rates, hospital costs and length of hospital stay of surviving patients, and incidence rate of adverse reactions of artificial liver support therapy between the two groups. The t-test was used for comparison of continuous data between the two groups, and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between the two groups. ResultsCompared with the non-artificial liver group, the artificial liver group had a significant reduction in the 28-day mortality rate of the patients with an MELD score of 30-39 (5.9% vs 39.6%, P＜0.001) or those with an MELD score of 40 (25.0% vs 72.7%, P＜0.05). Compared with the non-artificial liver group, the artificial liver group had a significant reduction in the 90-day mortality rate of the patients with an MELD score of 30-39 (23.5% vs 623%, P＜0.001). Artificial liver support therapy did not significantly shorten the mean hospital stay of the surviving patients (P＞0.05) and had no significant influence on the total hospital costs of the surviving patients within 90 days (P＞0.05). The incidence rate of adverse reactions related to artificial liver support therapy was 29.1%, but the symptoms were mild and were relieved after symptomatic treatment. ConclusionPatients with an MELD score of ＜30 in the plateau stage tend to have low 28- and 90-day mortality rates, and artificial liver support therapy can be reasonably selected according to the patient’s economic conditions and willingness. Artificial liver support therapy is recommended for patients with an MELD score of 30-39 in the plateau stage if there is no obvious contraindication. For patients with an MELD score of 40 in the plateau stage, artificial liver support therapy is recommended within 28 days if there is no obvious contraindication, and liver transplantation is recommended as soon as possible. Artificial liver support therapy has no significant influence on the total hospital costs and mean hospital stay of the surviving patients within 90 days and does not increase the economic burden of patients.