# Comparison of Two Artificial Liver Treatments for Acute Liver Failure: A Retrospective Observational Study

## TL;DR

This study compares two artificial liver treatments for acute liver failure, finding that combining DPMAS with plasma exchange improves some liver function markers, while plasma exchange alone is better for others.

## Contribution

The study provides new clinical data comparing PE alone and DPMAS + PE in acute drug-induced liver failure patients.

## Key findings

- DPMAS + PE improved alanine aminotransferase and aspartate aminotransferase levels more than PE alone.
- PE alone was more effective in improving total bilirubin and international normalised ratio levels.
- Specialised nursing is crucial for monitoring and managing complications in both treatment groups.

## Abstract

Liver failure can lead to severe disorders in the body's metabolism, detoxification, synthesis and other functions, with a high mortality rate of 60%–90%. The dual plasma molecular adsorption system (DPMAS) is a new artificial liver technology that has received much attention in recent years. However, it cannot provide coagulation factors, albumin or other substances during the treatment process and may even consume albumin during the adsorption process. The DPMAS typically needs to be used in combination with plasma exchange (PE). Few studies have compared PE alone and DPMAS + PE.

This study aimed to explore the clinical efficacy and nursing methods of different artificial liver treatments for patients with acute drug‐induced liver injury.

The clinical data of patients with liver failure admitted to the intensive care unit of our hospital were retrospectively analysed to identify a PE group and a sequential PE group, comprising DPMAS with PE (DPMAS + PE). The changes in liver function and coagulation function index before and after treatment and the occurrence of adverse reactions were compared.

In total, n = 57 patients (PE n = 14, DPMAS + PE n = 43) participated in the study. There was no significant difference in alanine aminotransferase (ALT), aspartate aminotransferase (AST) or total bilirubin (TBIL) levels before treatment (p > 0.05). After treatment, ALT levels were higher in the PE group than in the DPMAS + PE group (317.72 ± 604.24 vs. 276.02 ± 763.04, respectively), whereas TBIL levels were lower in the former than in the latter (237.91 ± 124.34 vs. 297.95 ± 153.38). The international normalised ratio (INR) was higher in the DPMAS + PE group than in the PE group (1.84 ± 0.66 vs. 1.66 ± 0.72) and prothrombin activity (30.51 ± 7.91 vs. 34.62 ± 8.43) was lower, indicating that DPMAS + PE had a better effect on ALT and AST levels, but PE alone was more effective in improving TBIL and INR levels.

The two artificial liver treatments can improve markers of liver function in patients with liver failure and help with liver function recovery.

Both artificial liver therapies effectively support patients awaiting transplantation. Successful management, particularly of the combined DPMAS + PE modality, demands specialised nursing expertise. Nurses must vigilantly monitor circuit pressure and coagulation parameters and adjust anticoagulant doses proactively to ensure treatment safety and efficacy.

What is known about this topic?
○Liver failure is a severe condition with a high mortality rate, and liver transplantation is the ultimate treatment.○Artificial liver treatment is currently used as a bridge therapy to support patients with liver failure while awaiting transplantation.○Plasma exchange (PE) is an effective method for removing harmful substances and supplementing beneficial substances, improving liver function and survival rates.○The dual plasma molecular adsorption system (DPMAS) is a new artificial liver technology that removes bilirubin and inflammatory factors without losing autologous plasma.○Often, DPMAS needs to be used in combination with PE due to its inability to provide coagulation factors and other substances.
What this paper adds?
○This study compares the clinical efficacy and adverse reactions of PE and DPMAS + PE in patients with acute drug‐induced liver failure and provides data on the changes in liver function and coagulation function indexes before and after treatment.○In terms of efficacy, DPMAS + PE was found to be superior to PE alone in improving liver function, especially in reducing alanine aminotransferase and aspartate aminotransferase levels. However, PE alone had a better effect on improving total bilirubin and international normalised ratio levels.○Nursing observations: The study highlights the demand for specialised nursing knowledge in caring for these patients. This encompasses vigilant monitoring of the circuit and the patient, proactive prevention of complications and ensuring overall treatment safety.

What is known about this topic?
○Liver failure is a severe condition with a high mortality rate, and liver transplantation is the ultimate treatment.○Artificial liver treatment is currently used as a bridge therapy to support patients with liver failure while awaiting transplantation.○Plasma exchange (PE) is an effective method for removing harmful substances and supplementing beneficial substances, improving liver function and survival rates.○The dual plasma molecular adsorption system (DPMAS) is a new artificial liver technology that removes bilirubin and inflammatory factors without losing autologous plasma.○Often, DPMAS needs to be used in combination with PE due to its inability to provide coagulation factors and other substances.

Liver failure is a severe condition with a high mortality rate, and liver transplantation is the ultimate treatment.

Artificial liver treatment is currently used as a bridge therapy to support patients with liver failure while awaiting transplantation.

Plasma exchange (PE) is an effective method for removing harmful substances and supplementing beneficial substances, improving liver function and survival rates.

The dual plasma molecular adsorption system (DPMAS) is a new artificial liver technology that removes bilirubin and inflammatory factors without losing autologous plasma.

Often, DPMAS needs to be used in combination with PE due to its inability to provide coagulation factors and other substances.

What this paper adds?
○This study compares the clinical efficacy and adverse reactions of PE and DPMAS + PE in patients with acute drug‐induced liver failure and provides data on the changes in liver function and coagulation function indexes before and after treatment.○In terms of efficacy, DPMAS + PE was found to be superior to PE alone in improving liver function, especially in reducing alanine aminotransferase and aspartate aminotransferase levels. However, PE alone had a better effect on improving total bilirubin and international normalised ratio levels.○Nursing observations: The study highlights the demand for specialised nursing knowledge in caring for these patients. This encompasses vigilant monitoring of the circuit and the patient, proactive prevention of complications and ensuring overall treatment safety.

This study compares the clinical efficacy and adverse reactions of PE and DPMAS + PE in patients with acute drug‐induced liver failure and provides data on the changes in liver function and coagulation function indexes before and after treatment.

In terms of efficacy, DPMAS + PE was found to be superior to PE alone in improving liver function, especially in reducing alanine aminotransferase and aspartate aminotransferase levels. However, PE alone had a better effect on improving total bilirubin and international normalised ratio levels.

Nursing observations: The study highlights the demand for specialised nursing knowledge in caring for these patients. This encompasses vigilant monitoring of the circuit and the patient, proactive prevention of complications and ensuring overall treatment safety.