Artificial liver treatment improves survival in patients with hepatitis B virus‐related acute‐on‐chronic liver failure: A case‐control matched analysis
Lingling Yang, Tianzhou Wu, Li Jiang, Jiang Li, Jiaojiao Xin, Dongyan Shi, Jing Jiang, Xi Liang, Yingyan Lu, Heng Yao, Huafen Zhang, Suwan Sun, Li Tan, Hozeifa Mohamed Hassan Mohamed, Jiaqi Li, Jiaqi Li, Keke Ren, Beibei Guo, Xingping Zhou, Jiaxian Chen, Shaorui Hao, Jiajia Chen, Shaojie Xin, Chen Pan, Tao Han, Yongping Chen, Shumei Lin, Zhongping Duan, Xiaowei Xu, Jianrong Huang, Xin Chen, Lanjuan Li, Jun Li, Jun Li, Chinese Group on the Study of Severe Hepatitis B (COSSH)
Abstract
AIM: The artificial liver support system (ALSS) is recognized as a bridge to liver transplantation in hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) patients. However, patient survival remains unknown. We aim to assess the effects of ALSS on survival in HBV-ACLF patients. METHODS: The clinical data of HBV-ACLF patients receiving standard medical treatment (SMT) plus ALSS (ALSS group, n = 507) or only SMT (SMT group, n = 417) were collected for survival assessment. The main end-points were cumulative survival rates at days 21, 28, and 90. Four different rigorous analyses were carried out to reduce bias and confounding. RESULTS: In the entire cohort, the cumulative survival rates at days 21, 28, and 90 were significantly higher in patients who underwent ALSS treatment (73.3% vs. 59.6%, 69.2% vs. 56.6%, 56.5% vs. 49.1%, respectively, P < 0.01) than in those who underwent SMT only. In the 276-pair case-control matched cohort, a significantly higher survival rate was also observed in the ALSS group than in the SMT group on days 21, 28, and 90 (72.5% vs. 60.3%, 68.3% vs. 57.4%, 55.9% vs. 48.5%, respectively, P < 0.05), especially in patients with ACLF-1 and -2. By a multivariable-adjusted analysis, ALSS treatment was associated with a significantly lower risk of mortality, especially for ACLF-2 at days 21, 28, and 90. These findings were also confirmed through propensity score matching and inverse probability treatment weighting analysis. CONCLUSIONS: ALSS treatment can improve short-term survival and is associated with a significantly lower risk of short-term mortality in patients with HBV-ACLF, especially ACLF-2.