Clinical effect and prognosis analysis of different blood purification patterns in the treatment of acute liver failure in children

Abstract

Objective To compare the clinical efficacy of different blood purification methods in children with acute liver failure, and to explore the clinical application mode, time and prognosis of blood purification in children with acute liver failure. Methods The clinical data of 85 children with acute liver failure admitted to PICU of Hunan Children′s Hospital from January 2010 to October 2016 were retrospectively analyzed.Sixteen patients were treated with general integrated medical treatment(conservative group). Twenty-seven patients were treated with continuous venovenous hemodiafiltration (CVVHDF) model non-biological artificial liver on the basis of general integrated medical treatment(CBP group). Sixteen cases were treated with plasma exchange(PE group). Twenty-six cases were treated with plasma exchange combined with CVVHDF mode (combination group). The main biochemical indexes, coagulation function, model for end-stage liver disease(MELD) score and delta MELD before and after treatment among groups were compared. Results Compared with those before treatment, the improvement of liver function and prognosis in the conservative was not significant after treatment.There were significant differences in the improvement of liver function and prognosis among the other three groups treated with non-biological artificial liver.Comparing the biochemical indexes and prognosis of three groups of children treated with different modes of non-biological artificial liver, there was no significant difference in the total effective rate between PE group and CBP group[56.3% (9/16) vs 55.6% (15/27), P>0.05]. The total effective rate of combined group[84.6% (22/26)] was significantly higher than those of PE group and CBP group.There was no significant difference in the improvement of liver function between PE group and CBP group (all P>0.05), but the indexes of liver function in combined group were significantly lower than those in PE group and CBP group (P 40. Conclusion PE and CBP have a good effect on children with acute liver failure, and if combined with the two methods can improve the therapeutic effect.At the same time, MELD score should be monitored in children with acute liver failure, and non-biological artificial liver therapy should not be recommended for children with MELD 40. Key words: Acute liver failure; Non-biological liver support; Model for end-stage liver disease; Blood purification