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Artificial liver treatment improves survival in patients with hepatitis B virus‐related acute‐on‐chronic liver failure: A case‐control matched analysis
Author(s) -
Yang Lingling,
Wu Tianzhou,
Li Jiang,
Xin Jiaojiao,
Shi Dongyan,
Jiang Jing,
Liang Xi,
Lu Yingyan,
Yao Heng,
Zhang Huafen,
Sun Suwan,
Li Tan,
Mohamed Hassan Mohamed Hozeifa,
Li Jiaqi,
Ren Keke,
Guo Beibei,
Zhou Xingping,
Chen Jiaxian,
Hao Shaorui,
Chen Jiajia,
Xin Shaojie,
Pan Chen,
Han Tao,
Chen Yongping,
Lin Shumei,
Duan Zhongping,
Xu Xiaowei,
Huang Jianrong,
Chen Xin,
Li Lanjuan,
Li Jun
Publication year - 2020
Publication title -
hepatology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.123
H-Index - 75
eISSN - 1872-034X
pISSN - 1386-6346
DOI - 10.1111/hepr.13497
Subject(s) - propensity score matching , medicine , confounding , gastroenterology , liver transplantation , survival analysis , hepatitis b virus , cohort , proportional hazards model , transplantation , virus , immunology
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.