Effect and prognostic factors of the double plasma molecular adsorption system combined with partial plasma exchange (DPMAS-PPE) in patients with liver failure

Aim
Although the dual plasma molecule adsorption system combined with partial plasma exchange (DPMAS-PPE) has been shown to be effective in the treatment of patients with liver failure (LF), short-term prognostic adverse events remain difficult to avoid in clinical practice. These events are often accompanied by severe symptoms of inflammation and elevated cytokine levels. Therefore, it is important to analyze the relationship between serological indicators, cytokines, and short-term prognosis in LF patients. The aim of the study was to monitor changes in clinical serological, haematological, and cytokine indices in patients with LF before and after DPMAS-PPE treatment. Patients were grouped according to survival outcomes, and short-term prognostic predictors were identified by analyzing relationship between routine blood parameters, serologicals indicators, and cytokines in each group.

Material and methods
A total of 121 LF patients treated with DPMAS-PPE were included and divided into survival and death groups based on outcomes during clinical treatment or follow-up. Data on serum levels, complete blood counts, and cytokine expression were collected and analyzed between groups before treatment, during treatment, and during follow-up. Correlations between parameters were analyzed, and a short-term prognostic model for LF patients was constructed using multivariable regression.

Results
Compared with the survival group, the death group showed significantly higher of neutrophil percentage (N), neutrophil-to-lymphocyte ratio (NLR), the total bilirubin (TBIL), and creatinine (Cr) levels, as well as lower haemoglobin (HGB), albumin (ALB), and prothrombin activity (PTA) during treatment and follow-up (all p < 0.05). Receiver operating characteristic (ROC) analysis showed that N, NLR, and TBIL had good predictive performance for short-term mortality (AUC > 0.80). Elevated interleukin 6 (IL-6) expression indicated higher mortality risk within 4 weeks, whereas decreased granulocyte-colony stimulating factor (G-CSF) and increased epidermal growth factor (EGF) expression were associated with death within 12 weeks. Multivariate regression revealed that advanced disease stage and abnormal expression of IL-6, G-CSF, and EGF were independent predictors of poor short-term survival, with a C-index of 0.715 (95% confidence interval [CI]: 0.64-0.79; p < 0.05).

Conclusions
The causes of death in LF patients are often related to severe infections, coagulation dysfunction, renal insufficiency, refractory hyponatremia, and hypoalbuminemia. During DPMA-PPE treatment, laboratory indicators such as N, NLR, and TBIL can still be used as references for assessing the short-term prognosis of patients. In addition, high expression of IL-6 is a risk factor for death within 4 weeks in LF patients, while low expression of G-CSF and high expression of EGF are risk factors for death within 12 weeks. Finally, the multivariate regression model constructed using indicators such as IL-6, G-CSF, and EGF has a moderate effect.