P039 Standard-volume plasma exchange in acute liver failure: assessment of laboratory parameters and clinical outcomes

Abstract

<h3>Background</h3> Acute liver failure (ALF) is a life threatening syndrome defined by hepatic encephalopathy and an International Normalised Ratio greater than 1.5 in a patient with no underlying chronic liver disease. Plasma Exchange (PEX) is an extracorporeal procedure separating plasma constituents from cellular blood components by centrifugation and replaces it with stored plasma. A large randomised controlled trial in ALF demonstrated reduced mortality with high-volume PEX. The primary objective of this retrospective case-control study was to evaluate the effect of standard-volume (1.5 Total Blood volumes of plasma) PEX on clinical parameters and outcomes of ALF patients receiving PEX compared to those on standard medical treatment (SMT) only. <h3>Methods</h3> This study compared clinical parameters, organ failure scores, and outcomes in patients with paracetamol-induced ALF receiving PEX (n=16) and those not receiving PEX (n=68). Parameters were recorded at admission to the intensive care unit and then 24 hours after the last cycle of PEX, and at similar timepoints for non-PEX patients. Data was collected for all ALF patients admitted to St James’s University Hospital in Leeds, UK between 2017 and 2020. To further investigate the effects of different aetiologies of PEX and treatment options received, admission and outcome data was collected for a further 34 ALF patients admitted between 2011 and 2016 who did not receive PEX. <h3>Results</h3> Analysis of results in 16 PEX and 68 non-PEX patients found significant improvements in biochemical parameters in patients 24 hours after receiving PEX (INR, PT, ALT, Bilirubin; P&lt;0.01), compared to those who were on SMT only. The admission Sequential Organ Failure Assessment (SOFA) mortality predictive scores were significantly higher in the PEX group than non-PEX (P&lt;0.01), which may explain the difference in mortality rates found in this study (37% and 22% respectively). <h3>Conclusions</h3> Standard-Volume PEX is effective in improving clinical parameters in individuals with ALF compared to SMT. Patients are at lower risk of transfusion-related acute lung injuries and it is more cost-effective than high-volume PEX. This intervention could be considered for liver support until recovery or liver transplantation.