Therapeutic plasma exchange versus double plasma molecular absorption system in hepatitis B virus‐infected acute‐on‐chronic liver failure treated by entercavir: A prospective study
Background Therapeutic plasma exchange (TPE) and double plasma molecular absorption system (DPMAS) were two extracorporeal liver support systems. Few studies compared their efficacy profile. Objective This study was to compare the efficacy of TPE and DPMAS on acute‐on‐chronic liver failure (ACLF) ca...
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| Veröffentlicht in: | Journal of clinical apheresis 2017-12, Vol.32 (6), p.453-461 |
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| creator | Wan, Yue‐Meng Li, Yu‐Hua Xu, Zhi‐Yuan Yang, Jing Yang, Li‐Hong Xu, Ying Yang, Jin‐Hui |
| description | Background
Therapeutic plasma exchange (TPE) and double plasma molecular absorption system (DPMAS) were two extracorporeal liver support systems. Few studies compared their efficacy profile.
Objective
This study was to compare the efficacy of TPE and DPMAS on acute‐on‐chronic liver failure (ACLF) caused by hepatitis B virus (HBV‐ACLF).
Methods
60 HBV‐ACLF patients were enrolled and prospectively studied. All patients received entecavir therapy, and were assigned to TPE group (n = 33) and DPMAS group (n = 27). Primary end‐points were the effects of TPE and DPMAS on liver function and serum inflammatory markers.
Results
Serum procalcitonin, interleukin (IL)−6, and high sensitive C‐reactive protein (hsCRP) were significantly elevated in patients with HBV‐ACLF. TPE achieved significantly higher removal rates of total bilirubin (TBIL, P = .002), direct bilirubin (DBIL, P = .006), and hsCRP (P = .010) than DPMAS, but DPMAS displayed lower loss rate of albumin (P = .000). TPE and DPMAS resulted in similarly increased serum IL‐6 levels and comparable 12‐week survivals (P > .05). Multivariate analysis showed that hospital stay (Relative Risk [RR]: 1.062, 95% Confidence Interval [CI]: 1.011‐1.115, P = .016), prothrombin time (RR: 1.346, 95% CI: 1.077‐1.726, P = .010), and international normalized ratio (RR: 0.013, 95% CI: 0.006‐0.788, P = .041) were independent predictors for 12‐week survival. Both TPE and DPMAS treatments were well‐tolerated.
Conclusion
Compared to DPMAS, TPE was more efficient in eliminating TBIL, DBIL, and hsCRP, but it was associated with higher loss rate of albumin. TPE and DPMAS were similar in improving 12‐week survivals in HBV‐ACLF. |
| doi_str_mv | 10.1002/jca.21535 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1878823124</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1878823124</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3535-24b27b5566603b8d1b91d40c1e8f7bbb376c34263ab8fdba0d3c4f6697a395743</originalsourceid><addsrcrecordid>eNp1kctu1DAUhi0EokNhwQsgS2xgMa0dJ07CbhiVmyqxKWvLdk4Yjxw7-NKSHY_Q5-FxeBI8TMsCiY0t-Xz6zjn-EXpOyRklpDrfa3lW0YY1D9CKkr5bU0roQ7QiLWPrqm76E_Qkxj0hpO9Z8xidVB0jNSV8hX5e7SDIGXIyGs9Wxkli-K530n0FfA0h5ogHn5WF--rkLehsZcBSRR_mZLzDcYkJJmwc3sEsk0km4rf42oQcf_24NW4EnWDAUucE5cG7cuhd8K50tab0waM0NgfAKYA8oGrB4BIELYvlDd7gOfg4F02hcUx5WJ6iR6O0EZ7d3afoy7uLq-2H9eXn9x-3m8u1ZuVLyv6qalXTcM4JU91AVU-HmmgK3dgqpVjLNasrzqTqxkFJMjBdj5z3rWR909bsFL06essE3zLEJCYTNVgrHfgcBe3arqsYrQ7oy3_Qvc_BlekE7XnT9pRRUqjXR0qXlWKAUczBTDIsghJxCFSUQMWfQAv74s6Y1QTDX_I-wQKcH4EbY2H5v0l82m6Oyt8xc7ED</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1965791310</pqid></control><display><type>article</type><title>Therapeutic plasma exchange versus double plasma molecular absorption system in hepatitis B virus‐infected acute‐on‐chronic liver failure treated by entercavir: A prospective study</title><source>MEDLINE</source><source>Access via Wiley Online Library</source><creator>Wan, Yue‐Meng ; Li, Yu‐Hua ; Xu, Zhi‐Yuan ; Yang, Jing ; Yang, Li‐Hong ; Xu, Ying ; Yang, Jin‐Hui</creator><creatorcontrib>Wan, Yue‐Meng ; Li, Yu‐Hua ; Xu, Zhi‐Yuan ; Yang, Jing ; Yang, Li‐Hong ; Xu, Ying ; Yang, Jin‐Hui</creatorcontrib><description>Background
Therapeutic plasma exchange (TPE) and double plasma molecular absorption system (DPMAS) were two extracorporeal liver support systems. Few studies compared their efficacy profile.
Objective
This study was to compare the efficacy of TPE and DPMAS on acute‐on‐chronic liver failure (ACLF) caused by hepatitis B virus (HBV‐ACLF).
Methods
60 HBV‐ACLF patients were enrolled and prospectively studied. All patients received entecavir therapy, and were assigned to TPE group (n = 33) and DPMAS group (n = 27). Primary end‐points were the effects of TPE and DPMAS on liver function and serum inflammatory markers.
Results
Serum procalcitonin, interleukin (IL)−6, and high sensitive C‐reactive protein (hsCRP) were significantly elevated in patients with HBV‐ACLF. TPE achieved significantly higher removal rates of total bilirubin (TBIL, P = .002), direct bilirubin (DBIL, P = .006), and hsCRP (P = .010) than DPMAS, but DPMAS displayed lower loss rate of albumin (P = .000). TPE and DPMAS resulted in similarly increased serum IL‐6 levels and comparable 12‐week survivals (P > .05). Multivariate analysis showed that hospital stay (Relative Risk [RR]: 1.062, 95% Confidence Interval [CI]: 1.011‐1.115, P = .016), prothrombin time (RR: 1.346, 95% CI: 1.077‐1.726, P = .010), and international normalized ratio (RR: 0.013, 95% CI: 0.006‐0.788, P = .041) were independent predictors for 12‐week survival. Both TPE and DPMAS treatments were well‐tolerated.
Conclusion
Compared to DPMAS, TPE was more efficient in eliminating TBIL, DBIL, and hsCRP, but it was associated with higher loss rate of albumin. TPE and DPMAS were similar in improving 12‐week survivals in HBV‐ACLF.</description><identifier>ISSN: 0733-2459</identifier><identifier>EISSN: 1098-1101</identifier><identifier>DOI: 10.1002/jca.21535</identifier><identifier>PMID: 28304106</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Absorption, Physicochemical ; Acute-On-Chronic Liver Failure - drug therapy ; Acute-On-Chronic Liver Failure - therapy ; Acute-On-Chronic Liver Failure - virology ; acute‐on‐chronic liver failure ; Adult ; Antiviral Agents ; Apheresis ; artificial liver support system ; Bilirubin - isolation & purification ; C-Reactive Protein - isolation & purification ; C‐reactive protein ; double plasma molecular absorption system ; Female ; Guanine - analogs & derivatives ; Guanine - therapeutic use ; Health risk assessment ; Hepatitis ; Hepatitis B ; Hepatitis B virus ; Humans ; interleukin‐6 ; Liver ; Male ; Middle Aged ; Multivariate analysis ; Plasma ; Plasma Exchange ; procalcitonin ; Prospective Studies ; Survival Analysis ; therapeutic plasma exchange</subject><ispartof>Journal of clinical apheresis, 2017-12, Vol.32 (6), p.453-461</ispartof><rights>2017 Wiley Periodicals, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3535-24b27b5566603b8d1b91d40c1e8f7bbb376c34263ab8fdba0d3c4f6697a395743</citedby><cites>FETCH-LOGICAL-c3535-24b27b5566603b8d1b91d40c1e8f7bbb376c34263ab8fdba0d3c4f6697a395743</cites><orcidid>0000-0002-6381-922X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fjca.21535$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fjca.21535$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>315,781,785,1418,27929,27930,45579,45580</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28304106$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wan, Yue‐Meng</creatorcontrib><creatorcontrib>Li, Yu‐Hua</creatorcontrib><creatorcontrib>Xu, Zhi‐Yuan</creatorcontrib><creatorcontrib>Yang, Jing</creatorcontrib><creatorcontrib>Yang, Li‐Hong</creatorcontrib><creatorcontrib>Xu, Ying</creatorcontrib><creatorcontrib>Yang, Jin‐Hui</creatorcontrib><title>Therapeutic plasma exchange versus double plasma molecular absorption system in hepatitis B virus‐infected acute‐on‐chronic liver failure treated by entercavir: A prospective study</title><title>Journal of clinical apheresis</title><addtitle>J Clin Apher</addtitle><description>Background
Therapeutic plasma exchange (TPE) and double plasma molecular absorption system (DPMAS) were two extracorporeal liver support systems. Few studies compared their efficacy profile.
Objective
This study was to compare the efficacy of TPE and DPMAS on acute‐on‐chronic liver failure (ACLF) caused by hepatitis B virus (HBV‐ACLF).
Methods
60 HBV‐ACLF patients were enrolled and prospectively studied. All patients received entecavir therapy, and were assigned to TPE group (n = 33) and DPMAS group (n = 27). Primary end‐points were the effects of TPE and DPMAS on liver function and serum inflammatory markers.
Results
Serum procalcitonin, interleukin (IL)−6, and high sensitive C‐reactive protein (hsCRP) were significantly elevated in patients with HBV‐ACLF. TPE achieved significantly higher removal rates of total bilirubin (TBIL, P = .002), direct bilirubin (DBIL, P = .006), and hsCRP (P = .010) than DPMAS, but DPMAS displayed lower loss rate of albumin (P = .000). TPE and DPMAS resulted in similarly increased serum IL‐6 levels and comparable 12‐week survivals (P > .05). Multivariate analysis showed that hospital stay (Relative Risk [RR]: 1.062, 95% Confidence Interval [CI]: 1.011‐1.115, P = .016), prothrombin time (RR: 1.346, 95% CI: 1.077‐1.726, P = .010), and international normalized ratio (RR: 0.013, 95% CI: 0.006‐0.788, P = .041) were independent predictors for 12‐week survival. Both TPE and DPMAS treatments were well‐tolerated.
Conclusion
Compared to DPMAS, TPE was more efficient in eliminating TBIL, DBIL, and hsCRP, but it was associated with higher loss rate of albumin. TPE and DPMAS were similar in improving 12‐week survivals in HBV‐ACLF.</description><subject>Absorption, Physicochemical</subject><subject>Acute-On-Chronic Liver Failure - drug therapy</subject><subject>Acute-On-Chronic Liver Failure - therapy</subject><subject>Acute-On-Chronic Liver Failure - virology</subject><subject>acute‐on‐chronic liver failure</subject><subject>Adult</subject><subject>Antiviral Agents</subject><subject>Apheresis</subject><subject>artificial liver support system</subject><subject>Bilirubin - isolation & purification</subject><subject>C-Reactive Protein - isolation & purification</subject><subject>C‐reactive protein</subject><subject>double plasma molecular absorption system</subject><subject>Female</subject><subject>Guanine - analogs & derivatives</subject><subject>Guanine - therapeutic use</subject><subject>Health risk assessment</subject><subject>Hepatitis</subject><subject>Hepatitis B</subject><subject>Hepatitis B virus</subject><subject>Humans</subject><subject>interleukin‐6</subject><subject>Liver</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Multivariate analysis</subject><subject>Plasma</subject><subject>Plasma Exchange</subject><subject>procalcitonin</subject><subject>Prospective Studies</subject><subject>Survival Analysis</subject><subject>therapeutic plasma exchange</subject><issn>0733-2459</issn><issn>1098-1101</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kctu1DAUhi0EokNhwQsgS2xgMa0dJ07CbhiVmyqxKWvLdk4Yjxw7-NKSHY_Q5-FxeBI8TMsCiY0t-Xz6zjn-EXpOyRklpDrfa3lW0YY1D9CKkr5bU0roQ7QiLWPrqm76E_Qkxj0hpO9Z8xidVB0jNSV8hX5e7SDIGXIyGs9Wxkli-K530n0FfA0h5ogHn5WF--rkLehsZcBSRR_mZLzDcYkJJmwc3sEsk0km4rf42oQcf_24NW4EnWDAUucE5cG7cuhd8K50tab0waM0NgfAKYA8oGrB4BIELYvlDd7gOfg4F02hcUx5WJ6iR6O0EZ7d3afoy7uLq-2H9eXn9x-3m8u1ZuVLyv6qalXTcM4JU91AVU-HmmgK3dgqpVjLNasrzqTqxkFJMjBdj5z3rWR909bsFL06essE3zLEJCYTNVgrHfgcBe3arqsYrQ7oy3_Qvc_BlekE7XnT9pRRUqjXR0qXlWKAUczBTDIsghJxCFSUQMWfQAv74s6Y1QTDX_I-wQKcH4EbY2H5v0l82m6Oyt8xc7ED</recordid><startdate>201712</startdate><enddate>201712</enddate><creator>Wan, Yue‐Meng</creator><creator>Li, Yu‐Hua</creator><creator>Xu, Zhi‐Yuan</creator><creator>Yang, Jing</creator><creator>Yang, Li‐Hong</creator><creator>Xu, Ying</creator><creator>Yang, Jin‐Hui</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-6381-922X</orcidid></search><sort><creationdate>201712</creationdate><title>Therapeutic plasma exchange versus double plasma molecular absorption system in hepatitis B virus‐infected acute‐on‐chronic liver failure treated by entercavir: A prospective study</title><author>Wan, Yue‐Meng ; Li, Yu‐Hua ; Xu, Zhi‐Yuan ; Yang, Jing ; Yang, Li‐Hong ; Xu, Ying ; Yang, Jin‐Hui</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3535-24b27b5566603b8d1b91d40c1e8f7bbb376c34263ab8fdba0d3c4f6697a395743</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Absorption, Physicochemical</topic><topic>Acute-On-Chronic Liver Failure - drug therapy</topic><topic>Acute-On-Chronic Liver Failure - therapy</topic><topic>Acute-On-Chronic Liver Failure - virology</topic><topic>acute‐on‐chronic liver failure</topic><topic>Adult</topic><topic>Antiviral Agents</topic><topic>Apheresis</topic><topic>artificial liver support system</topic><topic>Bilirubin - isolation & purification</topic><topic>C-Reactive Protein - isolation & purification</topic><topic>C‐reactive protein</topic><topic>double plasma molecular absorption system</topic><topic>Female</topic><topic>Guanine - analogs & derivatives</topic><topic>Guanine - therapeutic use</topic><topic>Health risk assessment</topic><topic>Hepatitis</topic><topic>Hepatitis B</topic><topic>Hepatitis B virus</topic><topic>Humans</topic><topic>interleukin‐6</topic><topic>Liver</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Multivariate analysis</topic><topic>Plasma</topic><topic>Plasma Exchange</topic><topic>procalcitonin</topic><topic>Prospective Studies</topic><topic>Survival Analysis</topic><topic>therapeutic plasma exchange</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wan, Yue‐Meng</creatorcontrib><creatorcontrib>Li, Yu‐Hua</creatorcontrib><creatorcontrib>Xu, Zhi‐Yuan</creatorcontrib><creatorcontrib>Yang, Jing</creatorcontrib><creatorcontrib>Yang, Li‐Hong</creatorcontrib><creatorcontrib>Xu, Ying</creatorcontrib><creatorcontrib>Yang, Jin‐Hui</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of clinical apheresis</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wan, Yue‐Meng</au><au>Li, Yu‐Hua</au><au>Xu, Zhi‐Yuan</au><au>Yang, Jing</au><au>Yang, Li‐Hong</au><au>Xu, Ying</au><au>Yang, Jin‐Hui</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Therapeutic plasma exchange versus double plasma molecular absorption system in hepatitis B virus‐infected acute‐on‐chronic liver failure treated by entercavir: A prospective study</atitle><jtitle>Journal of clinical apheresis</jtitle><addtitle>J Clin Apher</addtitle><date>2017-12</date><risdate>2017</risdate><volume>32</volume><issue>6</issue><spage>453</spage><epage>461</epage><pages>453-461</pages><issn>0733-2459</issn><eissn>1098-1101</eissn><abstract>Background
Therapeutic plasma exchange (TPE) and double plasma molecular absorption system (DPMAS) were two extracorporeal liver support systems. Few studies compared their efficacy profile.
Objective
This study was to compare the efficacy of TPE and DPMAS on acute‐on‐chronic liver failure (ACLF) caused by hepatitis B virus (HBV‐ACLF).
Methods
60 HBV‐ACLF patients were enrolled and prospectively studied. All patients received entecavir therapy, and were assigned to TPE group (n = 33) and DPMAS group (n = 27). Primary end‐points were the effects of TPE and DPMAS on liver function and serum inflammatory markers.
Results
Serum procalcitonin, interleukin (IL)−6, and high sensitive C‐reactive protein (hsCRP) were significantly elevated in patients with HBV‐ACLF. TPE achieved significantly higher removal rates of total bilirubin (TBIL, P = .002), direct bilirubin (DBIL, P = .006), and hsCRP (P = .010) than DPMAS, but DPMAS displayed lower loss rate of albumin (P = .000). TPE and DPMAS resulted in similarly increased serum IL‐6 levels and comparable 12‐week survivals (P > .05). Multivariate analysis showed that hospital stay (Relative Risk [RR]: 1.062, 95% Confidence Interval [CI]: 1.011‐1.115, P = .016), prothrombin time (RR: 1.346, 95% CI: 1.077‐1.726, P = .010), and international normalized ratio (RR: 0.013, 95% CI: 0.006‐0.788, P = .041) were independent predictors for 12‐week survival. Both TPE and DPMAS treatments were well‐tolerated.
Conclusion
Compared to DPMAS, TPE was more efficient in eliminating TBIL, DBIL, and hsCRP, but it was associated with higher loss rate of albumin. TPE and DPMAS were similar in improving 12‐week survivals in HBV‐ACLF.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>28304106</pmid><doi>10.1002/jca.21535</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-6381-922X</orcidid></addata></record> |
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| subjects | Absorption, Physicochemical Acute-On-Chronic Liver Failure - drug therapy Acute-On-Chronic Liver Failure - therapy Acute-On-Chronic Liver Failure - virology acute‐on‐chronic liver failure Adult Antiviral Agents Apheresis artificial liver support system Bilirubin - isolation & purification C-Reactive Protein - isolation & purification C‐reactive protein double plasma molecular absorption system Female Guanine - analogs & derivatives Guanine - therapeutic use Health risk assessment Hepatitis Hepatitis B Hepatitis B virus Humans interleukin‐6 Liver Male Middle Aged Multivariate analysis Plasma Plasma Exchange procalcitonin Prospective Studies Survival Analysis therapeutic plasma exchange |
| title | Therapeutic plasma exchange versus double plasma molecular absorption system in hepatitis B virus‐infected acute‐on‐chronic liver failure treated by entercavir: A prospective study |
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