Clinical efficacy of plasma exchange therapy in treatment of liver failure

Objective To investigate the clinical efficacy of plasma exchange( PE) in the treatment of liver failure. Methods A retrospective analysis was performed on the clinical data of patients with liver failure who were treated from January 2012 to June 2013 in our hospital. Thirty-three patients in PE group received PE in addition to medical comprehensive treatment,and 30 patients in control group were treated with medical comprehensive treatment. Clinical symptoms,complications,and the changes in biochemical markers of liver function were observed after 2 weeks of treatment,post-treatment outcomes were evaluated by 3-month followed-up,and the influential factors for efficacy were analyzed. Experimental data were expressed as mean ± standard deviation,continuous data were compared by t test,and categorical data were analyzed by chi-square test or Fisher's exact test. Results Symptoms such as fatigue,poor appetite,and abdominal distension were significantly relieved after PE. Post-treatment serum alanine aminotransferase( ALT) and total bilirubin( TBil) levels were significantly lower compared with pre-treatment levels( 390. 48 ± 536. 52 U /L vs 81. 03 ± 47. 58 U /L and 479. 27 ± 130. 01 μmol /L vs244. 64 ± 151. 05 μmol /L,P 0. 005),whereas post-treatment levels of albumin( Alb) and cholesterol( CHO) and prothrombin activity( PTA) were significantly higher than those measured before the treatment( 33.06 ±5.42 g/L vs 35.24 ±3.68 g/L,2.50 ±1.24 mmol/L vs 3. 59 ± 0. 86 mmol /L,and 34. 16% ± 5. 33% vs 73. 98% ± 27. 23%,P 0. 005). No significant differences were identified between pre-and post-treatment levels of ALT,TBil,Alb,CHO,and PTA( P 0. 05). Patients in PE group had a significantly higher improvement rate( χ2= 8. 276,P 0. 005) and a significantly lower mortality rate( χ2= 13. 258,P 0. 005) compared with the control group. The efficacy of PE was found to be correlated with pre-treatment TBil level,complications,bilirubin enzyme separation,and age ≥40 years( P 0.05). TBil and bilirubin enzyme separation were independent risk factors affecting the efficacy of PE( P 0.05,OR =1.01 and8. 75). Adverse reactions occurred in 8 cases during PE treatment,and disappeared after symptomatic treatment. Conclusion PE is a safe and effective treatment for liver failure,and holds promise for clinical application. TBil level and bilirubin enzyme separation are independent risk factors affecting the efficacy of PE.