Comparison of Acute on Chronic Liver Failure Prognostic Scores after Plasma Exchange and standard Medical Therapy

Abstract

Introduction: Acute and acute-on-chronic liver failure (ACLF) has a very high short-term mortality rate. Jaundice, hepatic encephalopathy, hepato-renal syndrome, hemodynamic instability, increased susceptibility to severe infections, and finally multi-organ failure may occur in the final stage of ACLF regardless of its underlying etiology. Biochemical parameters play a vital role in assessing the prognosis of the mortality rate of the disease. Aim of the study: This study aimed to compare acute on chronic liver failure prognostic scores in predicting short-term mortality rates after plasma exchange and standard medical therapy. Methods: This randomized control trial was conducted at the Department of Hepatology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from September 2020 to September 2021. All the patients admitted to the Department of Hepatology, BSMMU with ACLF were considered as the study population. A total of 28 patients (14 in each group of PLEX and SMT) were selected as study subjects by simple random sampling technique. All data were analyzed by SPSS version 21.0. Qualitative data were analyzed by Chi-square test and Quantitative data were analyzed by Student´s t-test. Comparison between the two groups in each follow-up was done by unpaired t-test. Result: The majority (57.1%) of patients survived in the PLEX group then 5(35.7%) in the SMT group. The difference was statistically not significant (p>0.05) between the two groups. Serum bilirubin, AST, ALT, MELD score, MELD-Na score, and AARC score were statistically significant (p<0.05) between the two groups. Conclusion: This study concludes that serum bilirubin, serum AST, serum ALT, MELD score, MELD-Na score, and AARC score are statistically significant in patients with ACLF. Serum bilirubin, serum AST, serum ALT, MELD score, MELD-Na score, and AARC score can act as predictors of short-term mortality rate in ACLF after plasma exchange and standard medical therapy.