Analysis on the factors influencing the prognosis of severe hepatitis patients treated by plasma exchange

Objective To study the effect and influencing factors of plasma exchange in the treatment of severe hepatitis.Methods Clinical data of 62 patients with severe hepatitis treated by plasma exchange were analyzed retrospectively.Results After plasma exchange,the effective rates(cure or improvement)of serve hepatitis at early stage,middle stage and late stage were 88.2%,64.3% and 23.5% respectively.The response rate was gradually lower along with the increase of age and the serum bilirubin before treatment and rise again of the serum bilirubin after plasma exchange,and along with the decrease of prothrobinogen activity and the serum albumin before treatment.Among all the complications,hepatic encephalopathy,hepatorenal syndrome,upper gastrointestinal bleeding had the worst prognosis.The levels of serum LPS,TNF-α,IL-18 and NO in effective group were lower than those in ineffective group before treatment.The levels of cytokines dropped in effective group when patients' condition ameliorated(P0.01),but there was no difference in the levels of cytokines when patients'condition aggravated as compared with those at admission in ineffective group(P0.05).Conclusion The stage of severe hepatitis,the levels of serum albumin,bilirubin,cytokines,PTA,and complications are relevant factors influencing the prognosis of patients with severe hepatitis treated by plasma exchange.