Safety and Efficacy of DPMAS in Patients With Acute-on-Chronic Liver Failure Based on Different Platelet Count Levels

To investigate the effect of different platelet (PLT) counts on the safety and efficacy of the double-plasma molecular absorption system (DPMAS) in patients with acute-on-chronic liver failure (ACLF). A total of 156 patients with ACLF receiving DPMAS were divided into the observed group (40 × 10⁹/L ≤ PLT < 50 × 10⁹/L) and the control group (PLT ≥ 50 × 10⁹/L) according to PLT count level. The safety and efficacy indices of bleeding-related complications, PLT reduction rate, total bilirubin (TBIL) reduction rate, and 28-days survival rate after DPMAS were analyzed and compared between the two groups. The incidence of bleeding complications during and after DPMAS in the observed and control groups (14.3% vs. 14.9%, p = 0.922), the decline rate of PLT immediately and 24 h after treatment (0.13 vs. 0.11/0.05 vs. 0.09, p = 0.256/0.161), and the 28-days survival rate after treatment (76.2% vs. 75.4%, p = 0.923) were not significantly different. The thromboelastogram before DPMAS showed no significant difference in PLT function between the two groups (p > 0.05). Although the TBIL level of the two groups rebounded 24 h after treatment compared with immediately after treatment, it decreased significantly immediately and 24 h after treatment compared with pre-treatment levels (p < 0.05). There was no significant difference in the rate of decline of serum TBIL immediately after treatment and 24 h after treatment between the two groups (0.33 vs. 0.35/0.14 vs. 0.16, p = 0.193 and 0.653, respectively). DPMAS is safe and effective in patients with ACLF with 40 × 10⁹/L ≤ PLT count < 50 × 10⁹/L.