Efficacy of Combined Plasma Exchange With Plasma Adsorption/Hemoperfusion Artificial Liver Support System ( ALSS ) in Treating Acute‐on‐Chronic Liver Failure due to Hepatitis B

Acute-on-chronic liver failure (ACLF) is the most prevalent type of liver failure in Asia, with hepatitis B virus (HBV) infection being the primary cause in our country. This study aimed to evaluate the effectiveness of the artificial liver support system (ALSS) in treating HBV-induced ACLF (HBV-ACLF) and assess the efficacy and safety of a combined ALSS model with small-volume plasma. A retrospective analysis compared the 4-week and 12-week survival rates of patients receiving comprehensive medical treatment versus ALSS treatment and identified factors associated with mortality. Patients undergoing the combined ALSS model (plasma exchange + double plasma adsorption system/hemoperfusion, PE + DPMAS/HP) were categorized into small-volume plasma and half-volume plasma groups. Changes in liver function, renal function, coagulation function, and blood ammonia levels following PE + DPMAS/HP treatment were analyzed. Mortality rates at 4 and 12 weeks were compared between the two groups, and factors influencing 4-week and 12-week mortality in HBV-ACLF patients were examined. The results indicated no significant difference in 4-week mortality between the ALSS and medical treatment groups; however, the ALSS group showed a significantly improved 12-week survival rate. Both small-volume and half-volume plasma ALSS models effectively eliminated bilirubin, bile acids, urea, and creatinine. No significant differences were observed in 4-week and 12-week mortality between the small-volume and half-volume plasma groups, regardless of the severity of HBV-ACLF (early, middle, or late stages). COX proportional hazard regression analysis revealed that the amount of plasma used in ALSS treatment was not a significant factor influencing HBV-ACLF prognosis. The combined ALSS model with reduced plasma usage may help alleviate the limited plasma supply and merits further application and promotion.