Chinese Hepatolgy ›› 2023, Vol. 28 ›› Issue (3): 334-339.

• Liver Failure • Previous Articles     Next Articles

Effects of reduced glutathione combined with plasma exchange and Double plasma molecular absorb system on acute-on-chronic liver failure and the establishment of a prognostic scoring model

XU Hai-ling1, ZHANG Ying2, YU Chong1, WANG Zhong-cheng3, CHEN Lin4   

  1. 1. Department of Liver Disease 1, Nantong Third People's Hospital,Affiliated Nantong Hospital 3 of Nantong University,Jiangsu 226006,China;
    2. Department of Critical Infection,Nantong Third People's Hospital、Affiliated Nantong Hospital 3 of Nantong University,Jiangsu 226006,China;
    3. Department of Integrated Chinese and Western medicine Hepatology,Nantong Third People's Hospital、Affiliated Nantong Hospital 3 of Nantong University,Jiangsu 226006,China;
    4. Institute of Liver Diseases,Nantong Third People's Hospital、Affiliated Nantong Hospital 3 of Nantong University,Jiangsu 226006,China
  • Received:2023-01-10 Online:2023-03-31 Published:2023-08-28
  • Contact: ZHANG Ying

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Abstract: Objective To explore the effect of reduced glutathione combined with plasma exchange and double plasma molecular absorb system (PE+DPMAS) on liver function of patients with acute-on-chronic liver failure and establish a prognostic scoring model. Methods A total of 84 patients with acute-on-chronic liver failure diagnosed from May 2018 to May 2021 were retrospectively selected. The patients were randomly divided into PE+DPMAS group (group A) and reduced glutathione+PE+DPMAS group (group B), with 42 cases in each group. The 6-month survival status of the patients was recorded. The patients in Group B were further divided into a survival group and a death group. The baseline data, liver function indexes and clinical efficacy after 2 months of treatment between these two groups were compared. The influencing factors of six-month survival were analyzed. The ROC model for predicting 6-month survival was established. Results The INR of group B and group A was 1.82 (1.48-2.20) and 2.18 (1.52-2.87), respectively (Z=-4.350, P=0.003); the level of Cr in group B and group A was 0.63 (0.40-0.71) and 0.78 (0.62～0.85), respectively (Z=-2.256, P=0.006); MELD score of group B and group A was 23.69 (17.85～27.02) and 24.67 (22.37～28.86), respectively (Z=-5.307, P<0.001); The MELD-Na score of group B and group A was 21.25 (16.69-29.95), and 25.66 (21.84-31.67), respectively (Z=-4.892, P<0.001). After 3 months of treatment, the AST level of group B and group A was 42.11±9.85 and 68.02±13.79, respectively (t=9.909, P<0.001); the level of TBIL in group B and group A was 21.55±6.32 and 32.77±6.09, respectively (t=8.285, P<0.001); γ-GT level in group B and group A was 32.55±9.07 and 78.05±15.79, respectively (t=16.193, P<0.001); the ALT level in group B and group A was 45.38±10.73 and 78.05±15.79, respectively (t=7.589, P<0.001). There was no death in both groups, and the total effective rate of 92.86% in group B was significantly higher than that of 76.19% in group A (χ2=4.459, P<0.05). According to the 6-month survival, patients in group B were divided into a survival group (25 cases) and a death group (17 cases). COX multivariate analysis showed that age (OR=1.013, 95%CI: 1.102-1.03), TBil (OR=1.003, 95%CI: 1.024-1.085), INR (OR=1.101, 95%CI: 1.132-2.387), PLT (OR=1.008, 95%CI: 1.092-1.101) were independent risk factors for the patients' survival. According to the COX results, a prediction model (A model) for the prognosis of liver failure in group B treatment was established. In the ROC curve, the AUC area of 0.752 (95%CI: 0.660-0.845) predicted by the A model was larger than that of 0.662 (95%CI: 0.557-0.768) by the MELD scoring model and 0.702 (95%CI: 0.605-0.799) by the MELD-Na scoring model. Conclusion Reduced glutathione+PE+DPMAS can significantly promote the recovery of liver function in patients with acute-on-chronic liver failure. Age, TBil, INR and PLT are independent risk factors for the patients' survival. The new A model is significantly better than traditional MELD score and MELD-Na in predicting the prognosis of patients' survival.    

Key words: Acute-on-chronic liver failure, reduced glutathione, plasma exchange, double plasma molecular absorb system, MELD score