HIỆU QUẢ CỦA THAY HUYẾT TƯƠNG TRÊN CHỨC NĂNG GAN TRONG ĐIỀU TRỊ BỆNH NHÂN SUY GAN CẤP, SUY GAN CẤP TRÊN NỀN MẠN

Abstract

Objective: Acute liver failure (ALF) and acute-on-chronic liver failure (ACLF) have high mortality rates. Plasma exchange therapy (TPE) in ALF and ACLF is a bridge to liver transplantation or a partial treatment in patients who are not eligible for liver transplantation. TPE is a process in which the patient's plasma is replaced with donor plasma, removing endotoxins, cytokines, and damage-associated molecules (DAMPS)... The study aims to determine the effectiveness of TPE in the treatment of patients with ALF or ACLF. Materials and methods: Case series, prospective study. 11 patients ≥ 18 years old diagnosed with acute liver failure or acute-on-chronic liver failure were treated with plasma exchange at the Intensive Care Unit Department of Nhan Dan Gia Dinh Hospital from the beginning of September 2023 to the end of September 2024. Results: 11 patients; of which 4 (36.4%) had drug-induced ALF, 1 (9.1%) had sepsis-induced ALF and 6 (54.5%) had hepatitis B-induced ACLF. Females accounted for 54.5%, with a mean age of 55.6 ± 14 (years). Mortality rate was 27.3% (3/11). Mean length of hospital stay was 20.2 ± 10.4 (days). One patient had grade 1 anaphylaxis due to fresh frozen plasma, with no recorded infectious or bleeding complications related to TPE... The majority of patients (63.6%) received TPE with 3 cycles. Most patients received TPE with 1.5 standard plasma volumes, only 1 patient received TPE with a high plasma volume. Most liver function tests improved after TPE. AST, ALT before TPE had mean values ​​of 815.9 ± 495.8 (UI/L), 580.4 ± 416.7 (UI/L), respectively; after TPE had mean values ​​of 216.7 ± 224.9 (UI/L), 146.3 ± 148.8 (UI/L), respectively. Liver enzymes before TPE decreased statistically significantly compared to after TPE with p values ​​of: 0.001; 0.004, respectively. At the same time, total bilirubin and direct bilirubin decreased statistically significantly when compared before and after TPE with p values ​​of 0.000; 0.001, respectively. INR before TPE had mean value of 3.0 ± 1.0, after TPE had mean value of 1.9 ± 1.0; The difference was statistically significant with p = 0.022. However, no statistically significant difference was noted when comparing NH₃ before and after TPE with p > 0.05. The study noted that all liver function test results improved statistically significantly after TPE cycle 1 with p<0.05. However, only ALT, total bilirubin, and direct bilirubin decreased statistically significantly when comparing before and after TPE cycle 2 with p values ​​of 0.031; 0.002; 0.002, respectively. When TPE cycle 3 was performed, all liver function tests did not show statistically significant differences when comparing before and after TPE. Conclusion: TPE in patients with ALF or ACLF improves liver function tests, thereby improving patient outcomes.