Effectiveness of multimodal artificial liver support for acute-on-chronic liver failure: A single-center cohort study

Multimodal artificial liver support (ALS) has been proven to be effective in a porcine model of acute liver failure. This study aimed to evaluate the curative effect in patients with acute-on-chronic liver failure (ACLF).

Data from ACLF patients receiving multimodal ALS between January 2014 and August 2019 were collected. Patients were divided into two groups according to the patterns of ALS: a trimodal ALS group (trimodal group) and a bimodal ALS group (bimodal group). A propensity score matching was performed to control for baseline bias between the groups. Survival rates and laboratory parameters were compared after single session and after completion of all the sessions of treatments.

A total of 182 patients undergoing multimodal ALS were screened. Propensity score matching generated 47 pairs. The short-term (28/90 days) survival rates were significantly higher in the trimodal group than those in the bimodal group (28-day survival rate: 91.5% vs. 76.6%, P = 0.049; 90-day survival rate: 91.5% vs. 74.5%, P = 0.027). The model for end-stage liver disease score was improved both after single session and after completion of all the sessions of treatments. Single session of trimodal ALS significantly reduced bilirubin (P < 0.001) and bile acid (P = 0.003) levels compared with bimodal ALS. Compared with baseline, gamma-glutamyltransferase (P = 0.001) and alkaline phosphatase (P = 0.021) levels were significantly decreased after completion of all the sessions of treatments in the trimodal group. However, no significant differences were observed in these two parameters within the bimodal group. Trimodal ALS was associated with increased clearance rates of interleukin-8 (P = 0.009) and macrophage migration inhibitory factor (P = 0.012). Multivariate Cox regression revealed that trimodal ALS was an independent predictor of lower 28- and 90-day mortality (both P < 0.05).

Trimodal ALS may provide a greater survival benefit for patients with ACLF, likely because of its superior ability to clear toxic substances and suppress inflammation.