Short Inter‐Treatment Interval Treatment With Artificial Liver Support System Reduces 90‐Day Transplant‐Free Mortality in Patients With Hepatitis B Virus–Related Acute‐On‐Chronic Liver Failure: A Retrospective Observational Study

AIM: This retrospective observational study aimed to compare the effects of short inter-treatment interval treatment (SIIT) versus long inter-treatment interval treatment (LIIT) using the artificial liver support system (ALSS) on liver function recovery and 90-day transplant-free mortality in patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). METHODS: We retrospectively analyzed 149 HBV-ACLF patients selected from 166 patients who received comprehensive internal medicine therapy combined with ALSS. Patients were categorized into the SIIT group and the LIIT group. Laboratory test data were recorded both before ALSS treatment and the seventh day after the last ALSS treatment. The 90-day transplant-free mortality was compared between the two groups. RESULTS: Biochemical indicators reflecting patient's liver function including alanine aminotransferase, aspartate aminotransferase, serum total bilirubin (TBIL), direct bilirubin (DBIL), total bile acid, and coagulation function (prothrombin time activity, PTA) were significantly improved at posttreatment than pretreatment in both groups (p < 0.05). At Day 7 after the last ALSS treatment, TBIL and DBIL levels were significantly lower in the SIIT group than in the LIIT group (p < 0.01). The 90-day transplant-free mortality in the SIIT group and LIIT group was 12.8% and 29.6%, respectively (p < 0.001). Higher baseline MELD score was associated with increased 90-day transplant-free mortality (OR = 1.815, 95% CI: 1.466-2.247, p < 0.001). CONCLUSIONS: In patients with HBV-ACLF, SIIT with ALSS was associated with reduced 90-day transplant-free mortality compared with LIIT, although prospective studies are required to confirm causality.