This study aimed to evaluate the association between metabolic syndrome (MetS) and clinical outcomes in patients hospitalized for acute-on-chronic liver failure (ACLF), and to establish a prognostic prediction model incorporating MetS. A retrospective cohort study was conducted involving 303 ACLF patients admitted to a tertiary hospital between May 2023 and May 2025. Patients were categorized into two groups based on their MetS status (MetS group vs. non-MetS group). The primary outcome was 90-day all-cause mortality. Propensity score matching (PSM) was employed to balance baseline characteristics. The association was assessed using multivariable Cox regression and logistic regression analyses after adjusting for confounders. Based on the results of the multivariable analysis, a nomogram model for predicting 90-day mortality was constructed. The model's discriminative ability, calibration, and clinical utility were evaluated in both the training and testing sets using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). After PSM, 206 patients (103 in the MetS group and 103 in the non-MetS group) were included in the final analysis. The 90-day mortality rate was significantly higher in the MetS group than in the non-MetS group (49.51% vs. 27.18%, p < 0.001). Multivariate Cox regression analysis showed that MetS, age, alanine aminotransferase (ALT), artificial liver support system (ALSS), transfusion times (TT), international normalized ratio (INR), C-reactive protein (CRP) and hepatocellular carcinoma (HCC) were independent predictors of 90-day death risk in patients with ACLF. The nomogram prediction model constructed based on these variables demonstrated excellent discriminative ability in both the training set (area under the curve, AUC = 0.877) and the testing set (AUC = 0.820). The calibration curve showed a high consistency between the predicted probabilities and the actual observations. Decision curve analysis confirmed the model's favorable net clinical benefit. MetS is an independent predictor of poor short-term prognosis in patients with ACLF, significantly increasing the risk of mortality. This study established a nomogram prediction model that integrates MetS, which can accurately assess patients' short-term mortality risk and may assist clinicians in early risk stratification.

Acute liver failure (ALF) and acute-on-chronic liver failure (ACLF) both have high mortality rates without liver transplantation. Artificial liver support systems may benefit patients with liver failure, serving as a bridge to transplantation or as a destination therapy allowing recovery. There are currently two types of artificial liver support systems: non-biological and biological. Non-biological artificial liver (NBAL) support systems primarily focus on detoxification by removing toxins through selective membranes and adsorbent materials. Well-known NBAL systems are plasma exchange, Molecular Adsorbent Recirculating System (MARS), Single-Pass Albumin Dialysis (SPAD), and the Fractionated Plasma Separation and Adsorption System (Prometheus). NBAL therapies consistently reduce bilirubin and improve encephalopathy; however, pivotal randomized controlled trials such as RELIEF (MARS) and HELIOS (Prometheus) did not confirm a survival advantage, although plasma exchange improved transplant-free survival in acute liver failure. Biological artificial liver (BAL) support systems use human or animal-derived hepatocytes to temporarily replace liver function, including the Extracorporeal Liver Assist Device (ELAD), HepatAssist, and stem-cell-based systems. Early BAL studies showed biochemical and neurological improvements, but large trials such as VTL-308 failed to demonstrate a significant survival benefit over standard medical therapy. Overall, while NBAL and BAL therapies can improve encephalopathy, renal function, and cholestasis, current evidence does not show a clear mortality benefit, and artificial liver support systems remain supportive rather than curative.

Prolonged Prothrombin Time: A Reliable Clinical Indicator of Therapeutic Efficacy for Chronic Liver Failure Treated With Artificial Liver Support System.

Acute liver failure accounts for a very fatal and severe complication. It is defined as acute liver injury with hepatic encephalopathy (HE) and an elevated international normalized ratio (INR above 1.5). There are multiple factors that can lead to acute liver failure. These different etiologies can vary depending on certain geographical areas where they are more prevalent than other factors in the area. Hepatitis caused by the Hepatitis A virus (HAV) is one of the leading causes of acute liver failure worldwide, especially in developing countries. Artificial Liver Support System (ALSS), on the other hand, consists of certain techniques by which the function of the liver is maintained artificially outside the body. These techniques try to filter out harmful substances and detoxify the blood. We report a 20-year-old male, with no known comorbidities, who presented to the medical outdoor with a history of high-grade fever for 5 days. On examination, the patient had mucocutaneous jaundice, moderate epigastric tenderness. His initial laboratory investigation showed Hb = 13.5, TLC = 6.8, PLT = 236, Pt = 22 (13 control), INR 1.7, Bilirubin total = 17.9, Bilirubin direct = 11.6, Bilirubin indirect = 6.3, AST = 5868, ALT = 5368, ALP = 160. His HbsAg and HCV by ELISA were negative, hepatitis E virus IgM was negative, and Hepatitis A IgM was positive. He was preliminarily diagnosed as a case of acute viral hepatitis A. He was shifted to the medical HDU for optimization. Over the next 12 h, the patient gradually deteriorated. He developed high-grade fever, 102°F, total bilirubin worsened, and hepatic encephalopathy grade II developed, with flapping tremors appreciated. The patient was shifted to the Medical Intensive Care Unit for monitoring and probable need for ventilatory support. Over the next 24 h, due to worsening clinical and biochemical parameters, it was decided to proceed with plasma exchange. Three sessions of plasma exchange were carried out, using eight units of fresh frozen plasma (approximately 1.6 L) as the replacement solution, over a period of 1.5 h for each session. The patient showed a marvelous improvement in clinical and biochemical parameters. He was admitted to the medical ICU for 7 days. He was stepped down to medical HDU for a further 2 days before being discharged. Low-volume plasma exchange therapy is a relatively safe option for young adult patients with fulminant hepatic failure secondary to hepatitis A infection. The therapy can be used early in the disease course when neurological signs/haptic encephalopathy start to develop. This can lead to a better prognosis and survival in selected patients.

Retraction Note: Elevated FDP levels independently predict poor outcomes in HBV-ACLF patients treated with artificial liver support system therapy.

Acute-on-chronic liver failure (ACLF) is the most prevalent type of liver failure in Asia, with hepatitis B virus (HBV) infection being the primary cause in our country. This study aimed to evaluate the effectiveness of the artificial liver support system (ALSS) in treating HBV-induced ACLF (HBV-ACLF) and assess the efficacy and safety of a combined ALSS model with small-volume plasma. A retrospective analysis compared the 4-week and 12-week survival rates of patients receiving comprehensive medical treatment versus ALSS treatment and identified factors associated with mortality. Patients undergoing the combined ALSS model (plasma exchange + double plasma adsorption system/hemoperfusion, PE + DPMAS/HP) were categorized into small-volume plasma and half-volume plasma groups. Changes in liver function, renal function, coagulation function, and blood ammonia levels following PE + DPMAS/HP treatment were analyzed. Mortality rates at 4 and 12 weeks were compared between the two groups, and factors influencing 4-week and 12-week mortality in HBV-ACLF patients were examined. The results indicated no significant difference in 4-week mortality between the ALSS and medical treatment groups; however, the ALSS group showed a significantly improved 12-week survival rate. Both small-volume and half-volume plasma ALSS models effectively eliminated bilirubin, bile acids, urea, and creatinine. No significant differences were observed in 4-week and 12-week mortality between the small-volume and half-volume plasma groups, regardless of the severity of HBV-ACLF (early, middle, or late stages). COX proportional hazard regression analysis revealed that the amount of plasma used in ALSS treatment was not a significant factor influencing HBV-ACLF prognosis. The combined ALSS model with reduced plasma usage may help alleviate the limited plasma supply and merits further application and promotion.

This study investigates the impact of the indirect bilirubin percentage-to-albumin ratio (iBAR) on the prognosis of patients with acute-on-chronic liver failure (ACLF), as defined by the Chinese Group on the Study of Severe Hepatitis B-ACLF (COSSH ACLF) criteria, who were treated with an artificial liver support system (ALSS). In a retrospective cohort of 258 eligible patients, restricted cubic splines, linear regression, and Cox proportional hazards models were used to analyse the association of iBAR with disease severity and 28-day and 90-day outcomes. The 28-day transplant-free and overall survival rates were 76.4% and 82.2%, respectively, while the 90-day rates were 58.5% and 66.3%. The iBAR was significantly lower in 28-day transplant-free survivors compared to those who underwent transplantation or died (6.47 ± 2.95 vs. 8.87 ± 2.49, p < 0.001), with similar findings for 90-day outcomes (6.09 ± 2.75 vs. 8.38 ± 2.88, p < 0.001). A positive association was observed between iBAR and COSSH ACLF score (adjusted β = 0.14, 95% CI: 0.11-0.18, p < 0.001). Furthermore, iBAR was independently associated with higher risks of 28-day transplant-free mortality (adjusted HR = 1.21, 95% CI: 1.10-1.34, p < 0.001), 28-day overall mortality (adjusted HR = 1.26, 95% CI: 1.12-1.42, p < 0.001), 90-day transplant-free mortality (adjusted HR = 1.13, 95% CI: 1.06-1.22, p < 0.001), and 90-day overall mortality (adjusted HR = 1.14, 95% CI: 1.05-1.23, p = 0.002). Patients with an iBAR > 6.13 had significantly poorer 28-day and 90-day prognoses compared to those with iBAR ≤ 6.13 (all adjusted HR > 1, p < 0.05). In conclusion, iBAR is positively associated with disease severity and adverse prognosis in COSSH ACLF patients receiving ALSS therapy, suggesting its potential as a prognostic biomarker that warrants validation in future prospective, multicenter studies.

Acute-on-chronic liver failure (ACLF) is a complex syndrome characterized by acute hepatic decompensation superimposed on pre-existing chronic liver disease or cirrhosis that is associated with acute worsening of portal hypertension, increased risk of infection, organ dysfunction and high short-term mortality. This Review provides a comprehensive update on definitions, pathophysiological mechanisms, clinical presentation and management of ACLF. The severe hepatic injury in ACLF triggers systemic inflammation, which is driven by damage-associated molecular patterns, gut-derived microbial products, and immunometabolic and functional dysregulation. Immune dysfunction can range from hyperinflammation and hypercytokinaemia to immune paresis, which in turn predisposes patients to infection and organ failure. The principles of ACLF management prioritize ameliorating the acute hepatic insult, managing portal hypertension, preventing organ failure and optimizing patients who are eligible for liver transplantation. Emerging options include novel therapies targeting immune modulation and liver regeneration, therapeutic plasma exchange and artificial liver support systems. Well-defined criteria for prompt interventions and selection of patients for transplantation within the first week after diagnosis - the 'golden window' - have improved outcomes of liver transplantation in patients with ACLF. The Kyoto ACLF Consensus reflects global efforts on unifying definitions, simplifying treatment end points, refining prediction tools, and filling the void of targeted non-transplantation interventions to improve outcomes in patients with ACLF; however, large knowledge gaps remain and further research is needed.

BackgroundPlatelet reduction is associated with an increased risk of bleeding in patients with chronic liver disease. However, the association between platelet levels and bleeding events in patients with liver failure treated with an artificial liver support system (ALSS) remains unclear.MethodsThis retrospective study included patients with acute-on-chronic liver failure (ACLF) who received ALSS treatment. Logistic and linear regression analyses were employed to assess the association between platelet levels and bleeding events during hospitalization and the relationship between sessions of ALSS treatment and platelet reduction rates.ResultsWe included 262 patients, of whom 56 (21.4%) experienced bleeding events during hospitalization. Baseline platelet levels in patients with bleeding events were significantly lower than those in patients without bleeding events (59.0 (39.0 ~ 89.3) × 109/L vs. 88.5 (57.0 ~ 121.0) × 109/L; p < 0.001). Baseline platelet levels were negatively associated with bleeding events (adjusted OR, 0.986; 95% CI, 0.976–0.996; p = 0.006), whereas platelet reduction rates and final platelet levels were not significantly associated with bleeding events (all p > 0.05). Compared to patients with baseline platelet grade 0, the risk of bleeding was significantly higher compared to those with baseline platelet grade 1 (adjusted OR: 3.21, 95% CI: 1.20 ~ 8.59, p = 0.002) and grade 2 (adjusted OR: 7.20, 95% CI: 2.28 ~ 21.43, p = 0.001), as well as in the combined group of grades 2 and 3 (adjusted OR: 8.43, 95% CI: 2.96 ~ 23.99, p < 0.001). The number of ALSS treatment sessions was not significantly associated with platelet reduction rates (p > 0.05).ConclusionPatients with ACLF who underwent ALSS treatment with lower baseline platelet levels were at an increased risk of bleeding during hospitalization, whereas the platelet reduction rate was not independently associated with bleeding risk. These findings underscore the importance of baseline platelet count rather than platelet reduction for early risk stratification in patients with ACLF.

In this retrospective study, the short-term efficacy of the plasma exchange-based artificial liver support system (PE-ALSS) for chronic severe hepatitis B (CSHB) was explored. We selected 111 CSHB patients and divided them into control (53 cases with conventional treatment) and research (58 cases with conventional treatment+PE-ALSS) groups based on the treatment they received. We then conducted inter-group comparisons regarding therapeutic effectiveness, complications, hepatic function indicators (alanine aminotransferase [ALT], aspartate aminotransferase [AST], total bilirubin [TBIL]), hepatic fibrosis markers (hyaluronic acid [HA], laminin [LN], type IV collagen [IV-C]), serum biochemical indices (interleukin [IL]-18, intercellular adhesion molecule-1 [ICAM-1]), coagulation function indices (prothrombin time [PT], thrombin time [TT], activated partial thromboplastin time [APTT]), and inflammatory factors (procalcitonin [PCT], IL-6). Finally, efficacy-associated determinants were identified by univariate and multivariate analysis. The research group had a superior total effective rate (94.83% vs. 69.81%, P < 0.001) and a lower complication rate (1.72% vs. 13.21%, P < 0.001) than the control group. Post-treatment, the research group exhibited statistically lower ALT (65.59±14.21 U/L vs. 89.47±17.44 U/L), AST (78.12±19.63 U/L vs. 94.91±22.27 U/L), TBIL (24.45±5.46 μmol/L vs. 45.77±7.43 μmol/L), HA (84.83±7.00 ng/mL vs. 100.47±10.41 ng/mL), LN (69.90±8.18 ng/mL vs. 80.81±8.71 ng/mL), IV-C (76.21±5.52 ng/mL vs. 85.21±7.97 ng/mL), IL-18 (343.34±108.3 pg/mL vs. 543.92±138.18 pg/mL), ICAM-1 (282.57±128.8 μg/L vs. 406.3±158.26 μg/L), PT (13.79±4.03 s vs. 15.68±3.15 s), TT (17.97±2.91 s vs. 20.11±2.23 s), APTT (35.79±11.08 s vs. 40.06±8.09 s), PCT (2.25±0.91 μg/L vs. 3.24±1.15 μg/L), and IL-6 (46.33±10.21 pg/mL vs. 50.75±11.11 pg/mL) than controls. Moreover, treatment modality (B = -1.865, odds ratio = 0.155, 95% confidence interval: 0.038-0.628) was an independent determinant of efficacy (P=0.009). PE-ALSS has significant short-term efficacy for CSHB patients.

ABSTRACT Aims Previous studies have shown that hepatitis B virus (HBV)–related disease progression involves gut microbiota dysbiosis linked to inflammation, endotoxin translocation, and immune imbalance. While the artificial liver support system (ALSS) improves liver function and inflammation, its impact on the gut microbiome remains unclear. This study aimed to investigate changes in the gut microbiota of healthy individuals (healthy control [HC] group), patients with chronic hepatitis B (CHB group), patients with HBV‐related acute‐on‐chronic liver failure (HBV‐ACLF group), and patients after ALSS treatment. Methods This single‐center, prospective study enrolled 89 participants from the Infectious Disease Center of West China Hospital, Sichuan University, between October 2019 and December 2021, comprising the HC ( n = 11), CHB ( n = 24), HBV‐ACLF ( n = 54), and ALSS ( n = 39 patients from the HBV‐ACLF group who received three sessions of ALSS treatment) groups. We analyzed the diversity, composition, and characteristic microbial taxa of the gut microbiota under different disease conditions and evaluated the impact of ALSS treatment on gut microbiota dysbiosis. Fecal microbiota was analyzed by 16S ribosomal RNA sequencing. Microbial characteristics were assessed through α‐diversity (Chao1, Shannon, and Simpson indices) and β‐diversity (principal coordinate analysis). Statistical analysis was performed using the Kruskal–Wallis test, and the linear discriminant analysis (LDA) effect size (LEfSe) analysis was used to identify the characteristic microbial taxa among the different groups. Results ALSS treatment significantly reduced serum total bilirubin (HBV‐ACLF: 370.64 ± 113.13 vs. ALSS: 203.08 ± 118.70 µmol/L, t = 7.45, p &lt; 0.001), decreased creatinine levels (HBV‐ACLF: 107.14 ± 55.45 vs. ALSS: 82.43 ± 57.16 µmol/L, t = 2.11, p = 0.039), and modestly decreased albumin levels (HBV‐ACLF: 31.68 ± 3.62 vs. ALSS: 29.88 ± 4.01 g/L, t = 2.27, p = 0.026). Microbial richness was significantly lower in the CHB group compared with HC (Chao1 index: W = 198, p = 0.018). Microbial diversity also declined, with Shannon and Simpson indices significantly reduced in the HBV‐ACLF group compared with CHB (Shannon: W = 898, p = 0.007; Simpson: W = 883, p = 0.011), and similar reductions observed in the ALSS group (Shannon: W = 643, p = 0.013; Simpson: W = 660, p = 0.006). β‐diversity analysis revealed distinct microbial community structures among groups (Adonis R 2 = 0.98576, p = 0.042). LEfSe analysis showed enrichment of Escherichia–Shigella and Enterococcus in HBV‐ACLF, while ALSS reduced their relative abundance, suggesting a partial restoration of gut microbial balance. Conclusion This study demonstrates that patients with HBV‐ACLF experience significant gut microbiota dysbiosis, characterized by a decrease in beneficial bacteria and an increase in opportunistic pathogens. ALSS treatment partially restores microbiota balance, but does not fully restore it to a healthy state.

Liver failure is severe liver damage caused by multiple factors, with a very high mortality rate. Artificial liver support systems have become a core strategy for alternative or bridging therapy in the context of the rapid progression of liver failure and high mortality rates with comprehensive internal medicine therapy. Non-bioartificial livers mainly serve as partial substitutes for liver function improvement through procedures such as perfusion, dialysis, and filtration methods. Bioartificial livers provide liver support therapy for patients by integrating detoxification, synthesis, and metabolic functions to simulate hepatic biosynthesis, filling the gap that non-bioartificial livers cannot perform and addressing the difficulties of non-bioartificial livers' heavy reliance on blood products. This paper focuses on reviewing the basic and clinical research progress of bioartificial livers, providing a multidimensional perspective to accelerate their clinical translation.

Acute-on-chronic liver failure (ACLF), particularly when associated with hepatitis B virus (HBV) infection, is characterized by rapid deterioration of liver function, systemic inflammation, and high short-term mortality. Artificial liver support systems, such as the double plasma molecular adsorption system combined with plasma exchange, are increasingly used as bridging therapies; however, reliable prognostic indicators remain limited. This study evaluated the prognostic value of systemic immune-inflammatory markers – systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and C-reactive protein – in 100 patients with HBV-ACLF undergoing artificial liver therapy. Patients were categorized into improved and ineffective outcome groups, and inflammatory indices were measured before and after treatment. Posttreatment reductions in neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and C-reactive protein levels were significantly greater in the improved group (P < .05). While model for end-stage liver disease (MELD) scores differed significantly between the groups, SII alone showed no statistical difference. However, the combined use of the SII and MELD produced the highest prognostic accuracy (area under the curve = 0.854), outperforming either metric alone. In conclusion, our study suggests that the integration of inflammatory markers with traditional liver function scoring enhances predictive performance. Combining the SII with MELD provides a cost-effective, accessible, and dynamic prognostic tool for clinicians managing HBV-ACLF. This dual-marker approach enables better early risk stratification, informs clinical decision-making, and may guide the optimal timing of artificial liver therapy. The use of both indices may be particularly valuable in resource-limited or time-sensitive settings, where rapid treatment decisions are critical. Future prospective studies are warranted to validate these results and refine their clinical application.

Liver failure, whether due to alcoholic liver disease or hepatic malignancy, often leads to acute-on-chronic liver failure (ACLF), necessitating liver transplantation. A major challenge in managing these patients is the acute decompensation phase, during which hepatic toxins and inflammatory mediators accumulate, resulting in multi-system dysfunction. While liver transplantation remains the most effective treatment, artificial liver support systems, particularly extracorporeal blood purification, offer potential benefits. Hemoperfusion, utilizing solute adsorption via a solid agent, provides an alternative to conventional dialysis, which is limited by membrane permeability. In this case series, we report our experience using HA330 hemoperfusion in combination with standard therapy for liver failure patients treated at our single-center hospital from 2023 to 2024. Extracorporeal blood purification with an adsorptive cartridge (HA330, Jafron, China) was employed as an adjunctive strategy to standard care. Our findings suggest that hemoperfusion may serve as a valuable supportive therapy for liver failure patients requiring transplantation. However, larger cohort studies are necessary to confirm its safety and efficacy.

BackgroundLiver failure often results in significant coagulation dysfunction, which is a major complication. Artificial liver support systems (ALSS) have been used to ameliorate coagulation parameters, but the dynamic nature of these improvements and the development of predictive models remain insufficiently explored.ObjectiveThis study aimed to evaluate the effects of ALSS on coagulation function and to develop a dynamic prediction model using machine learning techniques to predict the improvement trends of coagulation parameters.MethodsA systematic search was conducted in PubMed, Embase, and other databases to identify relevant studies, resulting in 18 studies comprising 1771 patients. A meta-analysis was performed to assess the impact of ALSS on coagulation parameters, including international normalized ratio (INR), prothrombin time (PT), activated partial thromboplastin time (APTT), and fibrinogen levels. In addition, clinical data from the Medical Information Mart for Intensive Care database were used to construct prediction models using logistic regression, extreme gradient boosting, random forest, and long short-term memory networks.ResultsMeta-analysis results showed that ALSS significantly improved INR, PT, APTT, and fibrinogen levels (all P<.05), with the treatment efficacy varying by modality. Among the machine learning models, the random forest model demonstrated the best performance, achieving an area under the curve of 92.12%. Dynamic INR was identified as the key predictor for coagulation abnormalities.ConclusionsThis study systematically evaluated the effects of ALSS on coagulation function in patients with liver failure, demonstrating significant improvements in key parameters such as INR, PT, and APTT, with efficacy varying across different treatment modalities. Simultaneously, a machine learning model built using intensive care unit clinical data exhibited strong predictive capability for identifying the risk of coagulation dysfunction, particularly useful in supporting early-stage clinical recognition of high-risk patients and guiding personalized coagulation management strategies. It is important to emphasize that this model is positioned as a dynamic risk alert and assessment tool, intended to assist clinical baseline evaluation and nursing interventions, rather than serving as direct validation of ALSS therapeutic efficacy.

Acute liver failure (ALF) is a life‐threatening, multifactorial condition characterized by rapid progression, extensive hepatocellular necrosis, and high mortality rates. Current therapeutic options, including artificial liver support systems (ALSS) and liver transplantation, are limited by high costs, donor shortages, and insufficient efficacy. Mitochondrial dysfunction and necrotic cell death play central roles in both acute and chronic liver injury; however, their contribution to ALF remains poorly understood. In this study, self‐assembled procyanidin capsules (PC‐Ca) are developed with sustained antioxidant and anti‐inflammatory properties that selectively accumulate in the liver of an ALF model. These findings demonstrate that PC‐Ca significantly improves survival rates and more effectively mitigates liver injury, inflammation, and necrosis in thioacetamide (TAA)‐induced ALF in mice and rabbits than the standard clinical agent, N‐acetylcysteine (NAC). This protective effect is mediated through enhanced oxidative stress defense via activation of the KEAP1‐NRF2 axis and inhibition of necroptosis via the RIPK1/RIPK3/MLKL pathway. In addition, PC‐Ca preserves mitochondrial morphology and function via the PGAM5/DRP1/PINK1 pathway, offering hepatoprotection. These findings suggest that PC‐Ca represents a promising therapeutic strategy for ALF, with the modulation of mitochondrial homeostasis offering valuable insights for the development of next‐generation pharmacological interventions.

Acute-on-chronic liver failure (ACLF) is an extremely severe clinical syndrome, often associated with systemic inflammation, coagulation dysfunction, and fibrinolysis abnormalities. Fibrin degradation product (FDP), as a byproduct of fibrinolysis, is a crucial indicator reflecting the state of fibrinolysis. The objective of this study is to investigate the relationship between FDP levels and the 28-day mortality rate in patients with ACLF. We retrospectively enrolled 520 patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) who underwent artificial liver support system therapy and collected relevant clinical data at admission. Cox regression analysis was employed to investigate the relationship between FDP levels and the 28-day mortality rate, and the predictive value of FDP was evaluated using receiver operating characteristic (ROC) curves. Among the 520 eligible patients, the 28-day mortality rate was 20.2%. The FDP levels of surviving patients were significantly lower than those of deceased patients [6.15 (3.23–10.97) vs. 16.98 (9.58–28.93), P < 0.001]. Through multivariate Cox proportional hazards analysis, after adjusting for confounding factors, It was observed that for every 10 µg/mL increase in FDP levels, the risk increased by 12.8% [HR = 1.128 (95% CI: 1.044–1.219), P < 0.001]. Compared to patients with low FDP levels (< 11.1 µg/mL), patients with high FDP levels (≥ 11.1 µg/mL) demonstrated a markedly higher mortality risk [HR = 3.222 (95% CI: 1.999–5.192), P < 0.001]. Among various prognostic scores, the COSSH-ACLF score exhibited the largest area under the receiver operating characteristic curve (AUROC), comparable to that of FDP (P = 0.891), and its predictive performance was superior to that of FIB and D-dimer. Additionally, for patients who received three or more sessions of artificial liver support system therapy, those with high FDP levels had a significantly reduced 28-day mortality risk. Elevated FDP levels are associated with the 28-day prognosis in patients with HBV-ACLF. Moreover, undergoing multiple sessions of artificial liver treatment is associated with favorable survival outcomes for patients with high FDP levels (≥ 11.1 µg/mL).Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-24753-7.

BackgroundThis study aimed to evaluate the effectiveness and safety of the hybrid artificial liver support system (HALSS) in patients with chronic liver failure (CLF). It also sought to analyze the inflammatory response and patient prognosis.MethodsA total of 126 CLF patients were divided into three treatment groups: plasma exchange (PEG), double plasma molecular adsorption system (DPMASG), and a combination therapy group (CG). Key parameters, including liver and kidney function, blood coagulation, T lymphocyte subgroups, and inflammatory cytokine levels (TNF-a, procalcitonin [PCT], interferon-gamma [IFN-g], IL-2, IL-6, and IL-10), were assessed before and after treatment. The clinical efficacy, adverse reactions, and short-term prognosis were compared across the groups.ResultsCompared to PEG and DPMASG, the combination group (CG) showed significant improvement in liver and kidney function markers, including reduced ALT, AST, total bilirubin (TBil), creatinine (Cr), INR, and prothrombin time (PT). Additionally, CG demonstrated increased levels of cholinesterase (ChE), albumin, and prothrombin activity (PTA). The CG group had a higher total clinical efficacy (92.0%) compared to PEG (76.3%) and DPMASG (78.9%). It also showed a lower rate of adverse reactions (8.0%) and improved one-year survival (36.0% vs. 18.4% and 21.1%, respectively). Furthermore, CG had the most favourable effects on inflammatory cytokine levels and T lymphocyte subsets, significantly reducing TNF-a, PCT, IFN-g, IL-2, IL-6, and IL-10.ConclusionsThe combination of PEG and DPMAS (HALSS) demonstrated superior clinical efficacy in improving liver and kidney function, reducing inflammation, and enhancing patient prognosis compared to single therapies. These findings support HALSS as a promising adjunctive therapy for CLF patients, improving short-term outcomes and long-term survival.

BackgroundLiver failure is associated with high short-term mortality, and the predictive value of clinical factors for patients undergoing artificial liver therapy is uncertain. We aim to develop prognostic models using several machine learning algorithms to predict 90-day survival in patients with liver failure undergoing artificial liver therapy.MethodsWe retrospectively enrolled hospitalized patients with liver failure who received artificial liver therapy in our center between December 2017 and December 2021. Prognostic characteristics were chosen by the least absolute shrinkage and selection operator (LASSO) regression and independent predictors by stepwise logistic regression analysis. Five machine learning algorithms—logistic regression (LR), random forest (RF), support vector machine (SVM), eXtreme Gradient Boosting (XGBoost), and k-nearest neighbor (KNN)—were used to build and validate models to predict 90-day survival following Artificial liver support systems. The model performance was assessed by the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, specificity, positive predictive value, and negative predictive value.ResultsA total of 197 patients were included in this study. LASSO regression, based on patient admission data, identified the top 15 prognostic features, and stepwise LR analysis determined that the age, direct bilirubin, retinol, alpha-fetoprotein, and thrombin time were independent predictors. Among the five machine learning models, LR achieved the highest predictive performance with an AUC of 0.884 and accuracy of 75.0%, followed by RF (AUC = 0.797), KNN (AUC = 0.788), XGBoost (AUC = 0.769), and SVM (AUC = 0.732). The predictive performance of LR models based on longitudinal data using patient characteristics from the day before treatment had an AUC of 0.869, and from the day after treatment, it had an AUC of 0.859.ConclusionMachine learning models showed promising performance in predicting 90-day survival in liver failure patients receiving artificial liver support therapy, potentially supporting individualized prognostic assessment.

BACKGROUNDLiver failure, particularly acute-on-chronic liver failure, is associated with high mortality (50%-90%). The plasma exchange (PE) mode of the artificial liver support system has been shown to improve clinical outcomes, although its efficacy may vary depending on the regenerative capacity of the liver. Alpha-fetoprotein (AFP), an oncofetal glycoprotein, is reactivated during liver regeneration and may serve as a prognostic biomarker. Previous studies have reported significantly higher post-PE AFP levels in survivors than in non-survivors (286.5 ng/mL vs 82.3 ng/mL at day 7). However, the predictive value of baseline AFP stratification and serial AFP kinetics during PE therapy remains unestablished. This study investigated whether serial AFP measurements predict clinical outcomes in liver failure patients receiving PE.AIMTo evaluate the predictive value of serial AFP measurements in liver failure patients receiving PE.METHODSThis retrospective study included 194 liver failure patients with complete AFP data, excluding those with tumors, bleeding disorders, allergies, or unstable conditions. Patients were stratified by baseline AFP into low-AFP (< 100 ng/mL, n = 60), medium-AFP (100-200 ng/mL, n = 70), and high-AFP (> 200 ng/mL, n = 64) groups. AFP was measured before PE and on days 1, 10, 20, and 25.RESULTSStratification by baseline AFP revealed significant gradients. The high-AFP group required fewer PE sessions than the low-AFP group (2.8 ± 1.0 vs 4.2 ± 1.5) but exhibited greater post-PE AFP elevation (75.1 ± 20.3 ng/mL vs 33.1 ± 10.2 ng/mL; P < 0.001). The high-AFP group demonstrated optimal values, including the lowest ammonia, bilirubin, alanine aminotransferase, aspartate aminotransferase, γ-glutamyl transferase, and the highest albumin and prothrombin activity (all post hoc P < 0.05 vs low-AFP). The medium-AFP group showed intermediate values except for prothrombin activity (35.2% ± 8.6%), which was significantly lower than in both other groups (P < 0.001). The high-AFP group had a reduced incidence of spontaneous bacterial peritonitis (9.4% vs 25.0%; P = 0.003), superior three-month survival (90.6% vs 56.7%; P < 0.001), and a higher post-treatment three-month receiver operating characteristic area under the curve (0.8851 vs 0.7051).CONCLUSIONAFP dynamics correlate with regenerative capacity and clinical outcomes in liver failure. Serial AFP monitoring may enhance risk stratification and support personalized therapeutic strategies.