Prospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 14, 2025; 31(14): 103892
Published online Apr 14, 2025. doi: 10.3748/wjg.v31.i14.103892
Efficacy of a novel artificial liver versatile plasma purification system in patients with acute-on-chronic liver failure
Zhong-Shang Dai, Min Zhang, Yuan-Ye Deng, Ning Zhou, Yi Tian
Zhong-Shang Dai, Min Zhang, Yuan-Ye Deng, Ning Zhou, Yi Tian, Department of Infectious Diseases, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
Co-first authors: Zhong-Shang Dai and Min Zhang.
Author contributions: Dai ZS and Zhang M contributed equally to this article; Dai ZS and Zhang M wrote the main manuscript text and prepared figures and tabs; Tian Y designed the study; Deng YY is responsible for data collecting; Zhou N analyzed all data; All authors reviewed the manuscript.
Supported by Natural Science Foundation of Hunan Province, China, No. 2022JJ30842 and No. 2024JJ6560; Clinical Medical Research Center for Viral Hepatitis of Hunan Province, No. 2023SK4009; and Beijing iGandan Foundation, No. RGGJJ-2021-017 and No. iGandanF-1082022-RGG023.
Institutional review board statement: The research was approved by the Ethics Committee of the Second Xiangya Hospital, No. 2022-53.
Clinical trial registration statement: This trial was registered at http://clinicaltrials.gov as (NCT06377774).
Informed consent statement: All study participants or their legal guardian provided informed written consent regarding personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: All data of this study are available from the corresponding author Yi Tian for reasonable request at tianyi@csu.edu.cn.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yi Tian, MD, Department of Infectious Diseases, The Second Xiangya Hospital, Central South University, No. 139 Renmin Middle Road, Changsha 410011, Hunan Province, China. tianyi@csu.edu.cn
Received: December 5, 2024
Revised: February 5, 2025
Accepted: March 26, 2025
Published online: April 14, 2025
Processing time: 128 Days and 17.8 Hours
Abstract
BACKGROUND

We have innovatively amalgamated membrane blood purification and centrifugal blood cell separation technologies to address the limitations of current artificial liver support (ALS) models, and develop a versatile plasma purification system (VPPS) through centrifugal plasma separation.

AIM

To investigate the influence of VPPS on long-term rehospitalization and mortality rates among patients with acute-on-chronic liver failure (ACLF).

METHODS

This real-world, prospective study recruited inpatients diagnosed with ACLF from the Second Xiangya Hospital of Central South University between October 2021 and March 2024. Patients were categorized into the VPPS and non-VPPS groups based on the distinct ALS models administered to them. Self-administered questionnaires, clinical records, and self-reported data served as the primary methods for data collection. The laboratory results were evaluated at six distinct time points. All patients were subjected to follow-up assessments for > 12 months. Kaplan-Meier survival analyses and Cox proportional hazards models were used to evaluate the risks of hospitalization and mortality during the follow-up period.

RESULTS

A cohort of 502 patients diagnosed with ACLF was recruited, with 260 assigned to the VPPS group. On comparing baseline characteristics, the VPPS group exhibited a significantly shorter length of stay, higher incidence of spontaneous peritonitis and pulmonary aspergillosis compared to the non-VPPS group (P < 0.05). Age [hazard ratio (HR) = 1.142, 95%CI: 1.01-1.23, P = 0.018), peritonitis (HR = 2.825, 95%CI: 1.07-6.382, P = 0.026), albumin (HR = 0.67, 95%CI: 0.46-0.942, P = 0.023), total bilirubin (HR = 1.26, 95%CI: 1.01-3.25, P = 0.021), international normalized ratio (HR = 1.97, 95%CI: 1.21-2.908, P = 0.014), and VPPS/non-VPPS (HR = 3.24, 95%CI: 2.152-4.76, P < 0.001) were identified as significant independent predictors of mortality in both univariate and multivariate analyses throughout the follow-up period. Kaplan-Meier survival analyses demonstrated significantly higher rehospitalization and mortality rates in the non-VPPS group compared to the VPPS group during follow-up of ≥ 2 years (log-rank test, P < 0.001).

CONCLUSION

These findings suggest that VPPS is safe and has a positive influence on prognostic outcomes in patients with ACLF.

Keywords: Acute-on-chronic liver failure; Artificial liver support; Versatile plasma purification system; Re-hospitalization frequencies; Mortality

Core Tip: In this study, we introduced a novel artificial liver support model, termed the Versatile Plasma Purification System (VPPS), aimed at treating patients with acute-on-chronic liver failure (ACLF). We demonstrated that the VPPS significantly enhances liver function, coagulation parameters, and blood ammonia levels in ACLF patients, as evidenced by a comparative analysis of laboratory data obtained prior to and following treatment with both VPPS and non-VPPS modes. Furthermore, our analysis revealed that patients receiving VPPS treatment exhibited reduced rates of readmission and mortality throughout the long-term follow-up period.