High‐volume plasma exchange in a patient with acute liver failure due to non‐exertional heat stroke in a sauna

Heat stroke is a life‐threatening condition characterized by an increased core body temperature (over 40°C) and a systemic inflammatory response, which may lead to a syndrome of multiple organ dysfunction. Heat stroke may be due to either strenuous exercise or non‐exercise‐induced exposure to a high environmental temperature. Current management of heat stroke is mostly supportive, with an emphasis on cooling the core body temperature and preventing the development of multiple organ dysfunction. Prognosis of heat stroke depends on the severity of organ involvement. Here, we report a rare case of non‐exercise‐induced heat stroke in a 73‐year‐old male patient who was suffering from acute liver failure after prolonged exposure in a hot sauna room. We successfully managed this patient by administering high‐volume plasma exchange, and the patient recovered completely after treatment. J. Clin. Apheresis 29:281–283, 2014. © 2014 Wiley Periodicals, Inc.     

A single center retrospective study: Comparison between centrifugal separation plasma exchange with ACD-A and membrane separation plasma exchange with heparin on acute liver failure and acute on chronic liver failure

The purpose of this retrospective study is to compare the efficacy and safety of the centrifugal separation therapeutic plasma exchange (TPE) using citrate anticoagulant (cTPEc) with membrane separation TPE using heparin anticoagulant (mTPEh) in liver failure patients. The patients treated by cTPEc were defined as cTPEc group and those treated by mTPEh were defined as mTPEh group, respectively. Clinical characteristics were compared between the two groups. Survival analyses of two groups and subgroups classified by the model for end-stage liver disease (MELD) score were performed by Kaplan–Meier method and were compared by the log-rank test. In this study, there were 51 patients in cTPEc group and 18 patients in mTPEh group, respectively. The overall 28-day survival rate was 76% (39/51) in cTPEc group and 61% (11/18) in mTPEh group (P > .05). The 90-day survival rate was 69% (35/51) in cTPEc group and 50% (9/18) in mTPEh group (P > .05). MELD score = 30 was the best cut-off value to predict the prognosis of patients with liver failure treated with TPE, in mTPEh group as well as cTPEc group. The median of total calcium/ionized calcium ratio (2.84, range from 2.20 to 3.71) after cTPEc was significantly higher than the ratio (1.97, range from 1.73 to 3.19) before cTPEc (P < .001). However, there was no significant difference between the mean concentrations of total calcium before cTPEc and at 48 h after cTPEc. Our study concludes that there was no statistically significant difference in survival rate and complications between cTPEc and mTPEh groups. The liver failure patients tolerated cTPEc treatment via peripheral vascular access with the prognosis similar to mTPEh. The prognosis in patients with MELD score < 30 was better than in patients with MELD score ≥ 30 in both groups. In this study, the patients with acute liver failure (ALF) and acute on chronic liver failure (ACLF) treated with cTPEc tolerated the TPE frequency of every other day without significant clinical adverse event of hypocalcemia with similar outcomes to the mTPEh treatment. For liver failure patients treated with cTPEc, close clinical observation and monitoring ionized calcium are necessary to ensure the patients' safety.     

双重血浆分子吸附联合血浆置换治疗慢加急性肝衰竭的疗效分析

目的 观察双重血浆分子吸附系统（DPMAS）联合血浆置换（PE）治疗慢加急性肝衰竭（ACLF）的疗效及安全性。方法 回顾性分析2016年1月至2018年12月我科收治并行人工肝治疗的乙型肝炎ACLF患者69例,其中DPMAS联合PE组32例,单纯PE组37例。观察两组治疗前后血清生化指标、凝血指标和血小板（PLT）的变化,观察疗效及不良反应。结果 两组4周总有效率和12周生存率差异无统计学意义。两组治疗后总胆红素（TBil）、白蛋白（ALB）、总胆汁酸（TBA）差异有统计学意义。两组治疗后与治疗前比较,肝功能及凝血功能均明显好转,差异有统计学意义;联合组PLT治疗前后差异有统计学意义。两组不良反应发生率差异无统计学意义（P＞0.05）。结论 DPMAS联合PE治疗ACLF疗效确切,能减少血浆用量,安全性较高。     

血浆置换、血液灌流在人工肝支持治疗中的比较

目的：比较血浆置换、血液灌流在人工肝支持治疗中的有效性和安全性。方法：对70例重症肝功能衰竭患者予以血浆置换、血液灌流两种模式的人工肝支持治疗，观察患者临床症状的变化，比较治疗前后电解质、肝肾功能、凝血酶原时间、部分凝血活酶时间的变化。结果：经过上述两种模式治疗后，患者的临床症状均有不同程度改善，血清总胆红素、血清肌酐、血清尿素氮、谷丙转氨酶、谷草转氨酶均明显下降（P〈0．01）；血浆置换组治疗结束时凝血酶原时间、部分凝血活酶时间均明显下降（P〈0．01）、血清白蛋白明显升高（P〈0．01）。二种模式治疗的不良反应均较轻。结论：两种治疗模式均能有效清除肝功能衰竭或合并肾功能衰竭产生的各种有毒物质。血浆置换治疗能调节水电解质平衡，血浆置换治疗后患者血清白蛋白浓度明显提高，出凝血功能明显改善。     

The treatment of acute liver failure with fractionated plasma separation and adsorption system: Experience in 85 applications

Introduction: Artificial liver support systems represent a potential useful option for the treatment of liver failure. The outcomes of patients treated with the fractionated plasma separation and adsorption (FPSA) system are presented. Patients and methods: FPSA was performed 85 times for 27 patients (median 3 treatments/patient) with liver failure [85.2% acute liver failure (ALF) and 14.8% acute‐on‐chronic liver failure] using the Prometheus 4008H (Fresenius Medical Care) unit. Citrate was used for anticoagulation. A variety of clinical and biochemical parameters were assessed. Comparisons between pretreatment and post‐treatment data were performed using paired t‐test. Results: The 85 sessions had a mean duration of 6 h. There were significant decreases in total bilirubin (13.18 ± 9.46 mg/dL vs. 9.76 ± 7.05 mg/dL; P < 0.0001), ammonia (167.6 ± 75 mg/dL vs. 120 ± 43.8 mg/dL; P < 0.0001), blood urea nitrogen (BUN; 12.55 ± 13.03 mg/dL vs. 8.18 ± 8.15 mg/dL; P < 0.0001), creatinine (0.54 ± 0.47 mg/dL vs. 0.46 ± 0.37 mg/dL; P = 0.0022) levels, and in pH (7.48 ± 0.05 vs. 7.44 ± 0.08; P = 0.0045). Four patients (14.8%) received liver transplantation after the treatments; in nine patients, transplantation was not necessary anymore (33%); the remaining 14 patients did not receive a transplantation because they were either not appropriate candidates or no organ was available. Overall survival was 48.1% (4 transplanted and 9 treated patients). No hematological complications related to FPSA were observed. Conclusions: FPSA system is a safe and effective detoxification method for patients with liver dysfunction, including ALF. The system is useful as a symptomatic treatment before liver transplantation; in up to 1/3 of the cases, it can even be used as a sole method of treatment. J. Clin. Apheresis 25:195–201, 2010. © 2010 Wiley‐Liss, Inc.     

血浆置换并联或串联血液滤过治疗肝衰竭疗效比较

目的 比较血浆置换(PE)并联或串联血液滤过(HF)治疗慢加亚急性肝衰竭的疗效.方法 将2006年1月-2007年8月住院的77例肝衰竭患者随机分为单纯PE组(39例)以及PE并联或串联HF组(PE+HF组,38例),并与同期住院未行人工肝支持治疗的患者(对照组,41例)进行对照,比较3组患者的存活率和生化指标改善情况.结果 3组患者治疗前生化指标比较差异均无统计学意义.PE组和PE+HF组治疗后血白蛋白(Alb)、胆碱脂酶(ChE)、凝血酶原活性(PTA)均升高,总胆红素(TBIL)、丙氨酸转氨酶(ALT)及天冬氨酸转氨酶(AST)均下降(P＜0.05或P＜0.01),提示生化指标均改善明显.PE组存活率为48.7%(19/39),PE+HF组为68.4%(26/38),对照组为29.3%(12/41),其中PE+HF组存活率显著高于对照组,差异有统计学意义(X2=12.11,P＜0.01).且PE+HF组治疗后肝性脑病患者意识转清率明显高于PE组(42.8%比0,P＜0.05).PE+HF组内环境紊乱纠正比例(19/23)较PE组(0/21)高(P＜0.05).结论 PE并联或串联HF治疗肝衰竭的疗效优于单用PE治疗.     

Early therapeutic plasma exchange may improve treatment outcomes in severe acute toxic Hepatitis

Background and objectivesAcute toxic hepatitis can result in a different clinical course from a completely curable disease to subacute hepatitis, chronic hepatitis, and fulminant hepatitis failure, which is quite mortal. For this purpose, therapeutic plasma exchange (TPE) can be used for improving treatment outcomes by reducing the harmful substances caused with and/or without liver function in acute toxic hepatitis. We aimed to evaluate treatment outcomes in severe acute toxic hepatitis patients who applied early TPE procedure.Materials and MethodsA total of 335 patients who received TPE between 2010–2021 were retrospectively screened and 59 (male/female, 30/29; min/max-age, 22–84) patients with acute toxic hepatitis who underwent TPE in the first 24 h were included in the study. TPE was performed in patients who had high total bilirubin level (>10 mg/dL). Laboratory parameters of the patients before and after the TPE procedure, number of patients developed complications of acute toxic hepatitis and mortality rates were evaluated for effectiveness of TPE.ResultsAcute toxic hepatitis was associated with hepatotoxic drugs in 44 (74.5 %), herbal medication 6 (10.2 %), mushroom poisoning 6 (10.2 %) and with substance abuse 3 (5.1 %) in patients. When the patients were compared based on INR, liver function tests, ammonia, lactate and Model For End-Stage Liver Disease (MELD) score at baseline, 48 h after TPE (independently of TPE number) and before final state a statistically significant decrease was observed in all parameters (p < 0.05). Fifty three (90 %) of patients improved without complications, the remaining 6 (10 %) patients were diagnosed with fulminant hepatitis. All these remaining patients died before liver transplantation (LTx) could be performed.ConclusionTPE is a safe, tolerable therapy option and early TPE may improve treatment outcomes in severe acute toxic hepatitis.     

血浆置换联合连续性血液滤过治疗急性肝衰竭

目的：研究血浆置换（PE）联合连续性静脉静脉血液滤过（CVVH）治疗急性肝衰竭（ALF）疗效及机制。方法：11例急性肝衰竭患者行PE联合CVVH治疗，治疗时间平均持续3．1d，于治疗前，PE后，CVVH6、12h，结束时分别抽血测肝肾功能、血氨、血清内毒素（ET）、TNF－α及IL－6的水平，并进行ICU监护。结果：在治疗过程中，血流动力学稳定，治疗后肝昏迷程度减轻，8例患者神志转清，清醒率为72．7％，SIRS积分从2．33分降到1．56分（P＜0．05），器官衰竭数从2．73降到1．36（P＜0．05），存活率为45．45％（5／11），肝脏病理检查发现能阻断肝细胞的进一步坏死。血浆置换后Bil-T、TBA、ET、TNF－α、IL－6明显下降（P＜0．01），凝血酶原活动度显著升高（P＜0．01）。CVVH治疗后TNF－α、IL－6、血氨、BUN、Cr呈进行性下降，而Bi1-T、TBA、ET变化不明显，与治疗前相比差异显著（P＜0．05）。结论：PE联合CVVH连续性治疗能有效清除急性肝衰竭ET和炎性介质TNF－α、IL－6水平，阻断肝细胞坏死，改善肝肾功能，在病程早期治疗能改善急性肝衰竭的预后。     

Clinical features and treatment of hypertriglyceridemia‐induced acute pancreatitis during pregnancy: A retrospective study

Aim : To analyze the features and treatment of hypertriglyceridemia‐induced acute pancreatitis (HTGP) during pregnancy. Methods : A retrospective study of 21 pregnant women diagnosed with acute pancreatitis (AP) was performed. Patients were divided into acute biliary pancreatitis (ABP), HTGP, and idiopathic groups according to etiology. Results : 95% of the patients were in the third trimester of gestation. The percentage of patients with HTGP was higher than that of ABP (48% vs.14%). The percentage of severe acute pancreatitis (SAP) in the HTGP group was higher than that in the ABP group (40.0% vs.0%). The Ranson scores for moderately severe acute pancreatitis (MSAP) and SAP in the HTGP group were significantly different (2.50 ± 0.58 vs.3.60 ± 0.89, P < 0.05, respectively). The mean serum triglyceride (TG) levels in the MSAP and SAP HTGP groups were not significantly different (18.81 ± 11.13 vs. 30.53 ± 24.20 mmol/L, P > 0.05, respectively). In the HTGP group, there were five patients given plasma exchange therapy and five not. Plasmapheresis decreased the incidence of systemic inflammatory response syndrome (SIRS) from 100% to 28.6% and the TG level from 20.36 ± 7.41 mmol/L to 5.23 ± 3.62 mmol/L (P < 0.05). The length of hospitalization of the plasmapheresis group was shorter than that of the nonplasmapheresis group (17.3 ± 6.7 days vs. 37.0 ± 20.8 days). Conclusions : Plasma exchange may be safe and effectively administered for HTGP patients during pregnancy with SIRS or multiple organ dysfunction syndrome (MODS). J. Clin. Apheresis 31:571–578, 2016. © 2015 Wiley Periodicals, Inc.     

人工肝血浆置换术在药物性肝功能衰竭患者中的应用

目的 探讨药物性肝功能衰竭患者行人工肝血浆置换术治疗后的临床效果,并观察相关并发症的护理防治措施.方法 采用回顾性的研究方法,收集2012年7月至2015年7月在本院感染内科住院的100例药物性肝功能衰竭患者的临床资料,所有患者在给予常规方法治疗的基础上(如降酶、退黄、护肝等),进一步给予人工肝血浆置换术治疗.观察患者治疗前、治疗后的凝血功能、肝功能相关指标的动态改变及自觉症状(如纳差、恶心、腹痛等)的改变状况,并进一步归纳患者行人工肝血浆置换术后相关的并发症,探讨并发症出现的因素和相关护理防治方法.结果 大部分患者行人工肝血浆置换术治疗后,纳差、恶心、腹痛等不适症状明显减轻,生命体征较之前明显改善;人工肝治疗后患者的血清丙氨酸氨基转移酶、总胆红素明显降低,与治疗前比较,差异有统计学意义(P<0.05);治疗后,患者的血清白蛋白、凝血功能明显增高,与治疗前比较,差异有统计学意义(P<0.05);治疗后,相关并发症的出现率分别是:对血浆过敏11例(11%)、血压降低5例(5%)、插管处出血2例(2%).结论 药物性肝功能衰竭患者采用人工肝血浆置换术治疗,能显著改善患者的肝功能,大大提高了药物性肝功能衰竭患者的救治成功率,值得临床推广应用.     

Postpartum plasma exchange as adjunctive therapy for severe acute fatty liver of pregnancy

Acute fatty liver of pregnancy (AFLP) is a rare disease of progressive hepatic insufficiency and secondary systemic compromise that poses significant fetal-maternal risk. Plasma exchange (PEX) is an effective bridge therapy to sustain liver function and enable hepatocellular regeneration to occur in nonpregnant patients following acute decompensation of a chronic liver disease or while awaiting liver transplantation. The application of PEX for patients with AFLP is a novel concept; since 1988 we have utilized postpartum PEX (PPEX) as adjunctive medical therapy for six patients with severe AFLP. Before PPEX initiation, four patients had signs and symptoms of encephalopathy, three required ventilatory support, five had advanced liver insufficiency, and all six were developing renal failure. PPEX was initiated 2-8 days following delivery and repeated (two to four times, mean = 3) at 24-48-h intervals thereafter. All patients responded with composite clinical (symptoms/signs) and laboratory improvement; the average length of hospitalization following final PPEX for five of six patients was 7 days. No significant PPEX-related complications occurred. PPEX utilization in patients with severe AFLP may enhance maternal recovery by preventing secondary sequelae from hepatic insufficiency until spontaneous healing can occur. Further study appears to be indicated to validate a role for PPEX as supportive therapy for puerperal patients with AFLP suffering multiorgan failure.