Fractionated plasma separation and adsorption integrated with continuous veno‐venous hemofiltration in patients with acute liver failure: A single center experience from China

Abstract

AbstractObjectiveTo evaluate the clinical efficacy and safety of fractionated plasma separation and adsorption integrated with continuous veno‐venous hemofiltration (FPSA‐CVVH) treatment in patients with acute liver failure (ALF).MethodsIn this retrospective study, we enrolled patients with ALF (serum total bilirubin >10 mg/dL or Model for End‐Stage Liver Disease [MELD] Score >18) hospitalized between August 2017 and August 2022. All patients had at least two sessions of FPSA‐CVVH. The primary measure of treatment efficacy was the reduction ratios (RRs) of bilirubin after each session of FPSA‐CVVH.ResultsSeventy‐eight patients with ALF were enrolled. The MELD score at baseline was 22.9 ± 7.5. The mean total bilirubin was 22.05 ± 5.94 mg/dL, direct bilirubin was 16.33 ± 4.60 mg/dL and indirect bilirubin was 3.43 ± 1.60 mg/dL. One hundred and eighty seven sessions of FPSA‐CVVH treatment lasting 8 hours each were performed. After a single session, serum total bilirubin, direct bilirubin and indirect bilirubin were significantly decreased. RRs were 52.0% ± 7.6% for total bilirubin, 59.4% ± 13.0% for direct bilirubin and 36.9% ± 15.4% for indirect bilirubin. Twenty nine patients (37.2%) survived and were discharged from the hospital, 12 of them recovered their liver function while the remaining 17 patients needed intermittent artificial liver support therapy.ConclusionFPSA‐CVVH therapy is an effective artificial liver support therapy in patients with ALF. It may be considered as a “bridge technique” to the recovery of liver function in critical ill patients with ALF.