Good Tolerance of Citrate Accumulation due to Plasma Exchange among Patients with Acute-on-Chronic Liver Failure: A Prospective, Observational Study

Aim. To assess the tolerance of citrate accumulation due to plasma exchange (PE) among patients with acute-on-chronic liver failure (ACLF). Methods. A prospective, observational study was conducted among patients with ACLF who received heparin anticoagulation during PE-centered therapy without filtration and dialysis. Citrate accumulation was defined as the value of total calcium (Catot) to ionized calcium (Caion) ratio (Catot/Caion) greater than or equal to 2.5 (Catot/Caion≥2.5). Results. Fifty-four patients were enrolled. The mean age and MELD score were 50.0 ± 11.3 years old and 25 ± 7, respectively. Thirty-three patients had liver cirrhosis. The total 3-month survival rate was 57.4% (31/54). The mean Catot/Caion at the time before PE was 2.05 ± 0.14. Catot/Caion≥2.5 occurred in 100.0% (54/54) and 29.6% (16/54) of patients with mean Catot/Caion of 4.34 ± 1.52 and 2.36 ± 0.32 immediately after PE and 1 hour after PE, respectively, and these levels were much higher than those before PE (p<0.01). However, all values returned to lower than 2.5 by the next morning with no difference from those before PE (2.10 ± 0.14 versus 2.05 ± 0.14, p>0.05). Hypocalcemia (ionized calcium) and mild alkalosis were the main metabolic alterations. No symptoms associated with hypocalcemia occurred. Conclusions. Citrate accumulation is well tolerated by patients with ACLF who receive PE-centered therapy without filtration and dialysis. This study is regeristed with ChiCTR-OOC-17013618.

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Safety and Efficacy of Regional Citrate Anticoagulation during Plasma Adsorption Plus Plasma Exchange Therapy for Patients with Acute-on-Chronic Liver Failure: A Pilot Study

Blood Purification ◽

10.1159/000500408 ◽

2019 ◽

Vol 48 (3) ◽

pp. 223-232 ◽

Cited By ~ 3

Author(s):

Yuanji Ma ◽

Fang Chen ◽

Yan Xu ◽

Ming Wang ◽

Taoyou Zhou ◽

...

Keyword(s):

Pilot Study ◽

Liver Failure ◽

Plasma Exchange ◽

Chronic Liver ◽

Regional Citrate Anticoagulation ◽

Chronic Liver Failure ◽

Safety And Efficacy ◽

Citrate Anticoagulation ◽

Citrate Accumulation ◽

Heparin Anticoagulation

Background: Patients with acute-on-chronic liver failure (ACLF) might be at risk for citrate accumulation during plasma adsorption plus plasma exchange (PE) therapy with regional citrate anticoagulation (RCA). Objectives: To assess the safety and efficacy of RCA during double plasma molecular adsorption system (DPMAS) plus PE therapy for patients with ACLF. Method: A prospective nonrandomized controlled pilot study was conducted at West China Hospital of Sichuan University. Patients with ACLF were enrolled to heparin anticoagulation (HA) group and RCA group. Serial blood samples were taken. Patients were followed up for 3 months. Results: Twenty-four patients with 94 sessions of HA and 28 patients with 106 sessions of RCA were enrolled. RCA method did not affect the therapeutic efficacy, the function of extracorporeal circulation, and the prognosis of these patients. The occurrences of citrate accumulation in RCA group were 0.0, 67.0, 100.0, 34.0, and 0.0% before DPMAS therapy, at the end of DPMAS therapy, immediately after PE therapy, 2 h after PE therapy, and the next morning, while that in HA group were 0.0, 0.0, 100.0, 7.4, and 0.0%, respectively. The occurrences of citrate accumulation at the end of DPMAS therapy and at 2 h after PE therapy in RCA group were much higher than that in HA group (67.0 vs. 0.0%, p = 0.000; 34.0 vs. 7.4%, p = 0.000, respectively). Although the trend of citrate accumulation in RCA group was much more obvious than that in HA group during and after DPMAS plus PE therapy (p = 0.000), the values on the next morning were similar between the 2 groups (p > 0.05). The main alteration of acid–base status was metabolic alkalosis with no difference between the 2 groups. Conclusions: RCA might be safe and effective in patients with ACLF receiving plasma adsorption plus PE therapy. RCA method might offer an alternative anticoagulation method for them.

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Prognostic Role of Bacterial and Fungal Infections in Patients With Liver Cirrhosis With and Without Acute-on-Chronic Liver Failure: A Prospective 2-Center Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa453 ◽

2020 ◽

Vol 7 (11) ◽

Author(s):

Michele Bartoletti ◽

Maurizio Baldassarre ◽

Marco Domenicali ◽

Russell E Lewis ◽

Maddalena Giannella ◽

...

Keyword(s):

Mortality Rate ◽

Observational Study ◽

Liver Failure ◽

Prospective Observational Study ◽

Fungal Infections ◽

Chronic Liver ◽

Decompensated Cirrhosis ◽

Chronic Liver Failure ◽

Term Survival

Abstract Background Bacterial and fungal infections (BFIs) are frequent in patients with cirrhosis and often trigger acute-on-chronic liver failure (ACLF). This prospective observational study aims to describe the interactions between BFI and ACLF in terms of mortality and related risk factors. Methods We performed a 2-center prospective observational study enrolling hospitalized patients with cirrhosis admitted for acute decompensation. Data were recorded at admission and during hospitalization. Survival was recorded up to 1 year. Results Among the 516 patients enrolled, 108 (21%) were infected at admission, while an additional 61 patients (12%) developed an infection during hospital stay. In the absence of ACLF, the 1-year mortality rate of patients with BFI did not differ from that of patients without BFI (33% vs 31%; P = .553). In contrast, those with ACLF triggered or complicated by BFI had a significantly higher mortality rate than those who remained free from BFI (75% vs 54%; P = .011). Competing risk analysis showed that the negative impact of ACLF-related BFI on long-term prognosis was independent from Model for End-stage Liver Disease (MELD) incorporating serum sodium concentration score, comorbidity, and basal C-reactive protein level. Finally, multivariable logistic regression showed that higher MELD score (P < .001), QuickSOFA score ≥2 points (P = .007), and secondary bloodstream (P = .022) and multidrug-resistant pathogen isolation (P = .030) were independently associated with ACLF in patients with BFI. Conclusions This large prospective study indicated that the adverse impact of BFI on long-term survival in decompensated cirrhosis is not universal but is limited to those patients who also develop ACLF. Both disease severity and microbiological factors predispose infected decompensated patients to ACLF.

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Low volume plasma exchange and low dose steroid improve survival in patients with alcohol related acute on chronic liver failure and severe alcoholic hepatitis –preliminary experience

Journal of Clinical and Experimental Hepatology ◽

10.1016/j.jceh.2021.07.010 ◽

2021 ◽

Author(s):

Santhosh E. Kumar ◽

Ashish Goel ◽

Uday Zachariah ◽

Sukesh C. Nair ◽

Vinoi George David ◽

...

Keyword(s):

Liver Failure ◽

Plasma Exchange ◽

Alcoholic Hepatitis ◽

Low Dose ◽

Chronic Liver ◽

Chronic Liver Failure ◽

Severe Alcoholic Hepatitis ◽

Low Volume

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Functional activin-HNF4A-coagulation axis in liver progenitor cells determines MELD score and outcome of acute-on-chronic liver failure

Journal of Hepatology ◽

10.1016/s0168-8278(20)31484-7 ◽

2020 ◽

Vol 73 ◽

pp. S503-S504

Author(s):

Tao Lin ◽

Shanshan Wang ◽

Rilu Feng ◽

Xiaodong Yuan ◽

Hui Liu ◽

...

Keyword(s):

Liver Failure ◽

Progenitor Cells ◽

Meld Score ◽

Chronic Liver ◽

Chronic Liver Failure

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Therapeutic plasma exchange in acute on chronic liver failure

Journal of Clinical Apheresis ◽

10.1002/jca.21799 ◽

2020 ◽

Vol 35 (4) ◽

pp. 316-327

Author(s):

Klaus Stahl ◽

Markus Busch ◽

Jan Fuge ◽

Andrea Schneider ◽

Michael P. Manns ◽

...

Keyword(s):

Liver Failure ◽

Plasma Exchange ◽

Chronic Liver ◽

Therapeutic Plasma Exchange ◽

Chronic Liver Failure

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Serum NGAL Is Superior to Cystatin C in Predicting the Prognosis of Acute-on-Chronic Liver Failure

Annals of Hepatology ◽

10.5604/01.3001.0012.2239 ◽

2018 ◽

Vol 17 (5) ◽

pp. 0-10

Author(s):

Jianchun Lu ◽

Lin Lin ◽

Chunyan Ye ◽

Qian Tao ◽

Manman Cui ◽

...

Keyword(s):

High Risk ◽

Liver Failure ◽

Cystatin C ◽

Risk Group ◽

Multivariate Logistic Regression Analysis ◽

Meld Score ◽

High Risk Group ◽

Chronic Liver ◽

Low Risk ◽

Chronic Liver Failure

Introduction and aim. Acute-on-chronic liver failure (ACLF) is a syndrome with high short-term mortality, and predicting the prognosis is challenging. This study aimed to compare the performance of neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C (CysC) in predicting the 90-day mortality in patients with hepatitis B virus (HBV)-associated ACLF (HBV-ACLF). Materials and methods. This prospective, observational study enrolled 54 patients with HBV-ACLF. The serum NGAL and CysC levels were determined. A multivariate logistic regression analysis was used to analyze the independent risk factors of mortality. Results. Serum NGAL, but not CysC, was found to significantly correlate with the total bilirubin, international normalized ratio, and model for end-stage liver disease (MELD). Serum NGAL [odds ratio (OR), 1.008; 95% confidence interval (CI), 1.004–1.012; P < 0.01], but not CysC, was an independent risk factor for developing hepatorenal syndrome. Moreover, NGAL (OR, 1.005; 95% CI, 1.001–1.010; P < 0.01) along with the MELD score was independently associated with the overall survival in patients with HBV-ACLF. Patients with HBV-ACLF were stratified into two groups according to the serum NGAL level at baseline (low risk: <217.11 ng/mL and high risk: ≥217.11 ng/mL). The 90-day mortality rate was 22.73% (5/22) in the low-risk group and 71.88% (23/32) in the high-risk group. Moreover, NGAL, but not CysC, significantly improved the MELD score in predicting the prognosis of HBV-ACLF. Conclusion. The serum NGAL might be superior to CysC in predicting the prognosis of HBV-ACLF with the normal creatinine level.

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