Abstract: Objective  To explore the efficacy of double plasma molecular adsorption system combined with half-dose plasma exchange (DPMAS+half-dose PE) in patients with hepatitis B-related acute-on-chronic liver failure.  Methods  A total of 100 patients with liver failure and undergoing artificial liver treatment at the First Affiliated Hospital of Xinxiang Medical University from January 2021 to December 2022 were retrospectively analyzed. Patients were divided into two groups based on the treatment mode: DPMAS+half-dose  PE (49 cases) and plasma exchange (PE) alone (51 cases). Changes of laboratory indicators and 28-day survival rate were compared between the two groups. Kaplan-Meier (K-M) method was used to plot survival curves. Log-rank test was employed to analyze survival difference between groups. Multivariate Cox regression analysis was used to identify the independent factors affecting patient prognosis.  Results  After treatment, levels of CRP [(9.9±4.5)mg/L vs. (12.9±5.0) mg/L], albumin [(27.38±3.94)g/L vs. (31.07±3.35)g/L], direct bilirubin [(102.3±54.9)μmol/L vs. 117.4±43.3)μmol/L] and indirect bilirubin [(69.9±43.4)μmol/L vs. (81.2±34.9)μmol/L] were lower in DPMAS+half-dose PE group than in PE group (t=-3.214, -5.064, -2.007 and -2.310 respectively; P=0.002, ＜0.001, 0.045 and 0.021 respectively). Both groups showed decreases of total bilirubin  (t=   -6.974, P＜0.001; t=-7.693, P＜0.001), direct bilirubin (t=-6.711, P＜0.001; t=-6.649, P＜0.001) indirect bilirubin (t=-7.365, P＜0.001; t=-7.713, P＜0.001), international normalized ratio (Z=-3.509, P=0.002; Z=-4.067, P＜0.001), CRP (t=6.602, P＜0.001; t=5.12, P＜0.001), and interleukin-6 (Z=-5.347, P＜0.001; Z=-4.615, P＜0.001), and increase of prothrombin activity (t=-3.322, P＜0.001; t=-5.201, P＜0.001) after treatment. The 28-day survival rate was higher in DPMAS+half-dose PE group than in PE group (χ2=4.209, P=0.040). Multivariate Cox regression analysis revealed that DPMAS+PE treatment (HR=0.832, 95% CI: 0.685～0.994, P=0.043), complications (HR=4.595, 95% CI:1.328～7.395, P=0.005), model for end-stage liver disease (MELD) score (HR=3.258, 95% CI: 1.247～5.593, P=0.009), and liver failure stage (HR=4.852, 95% CI: 1.352～7.529, P=0.002) were the independent factors affecting patient prognosis.  Conclusion  Both the two treatment modalities can improve liver function and coagulation indicators in the patients. DPMAS+half-dose PE group was superior in 28-day survival rate and can reduce the demand for blood transfusion, being a prognostic protective factor for the patients and worthy of clinical promotion.

Key words: Double plasma molecular adsorption system, Plasma exchange, Hepatitis B-related acute-on-chronic liver failure, Efficacy