The following is a summary of “Combination of Plasma Exchange and Adsorption Versus Plasma Exchange in Pediatric Acute Liver Failure: A Multicenter Cohort Study,” published in the June 2023 issue of Pediatrics by Gao, et al.
For a retrospective cohort study, researchers sought to compare the efficacy of double plasma molecular adsorption system (DPMAS) combined with half-dose plasma exchange (PE) to that of full-dose PE in pediatric acute liver failure (PALF) cases.
The multicenter study was conducted in 13 pediatric intensive care units in Shandong Province, China. A total of 78 cases were included, with 28 receiving DPMAS+PE therapy and 50 receiving single PE therapy. Clinical information and biochemical data were collected from the patients’ medical records.
There were no significant differences in the severity of illness between the two groups. After 72 hours of treatment, the DPMAS+PE group exhibited significantly higher rates of decline in the Pediatric model for End-stage Liver Disease and Pediatric Sequential Organ Failure Assessment scores, as well as in total bilirubin, blood ammonia, and interleukin-6 levels, compared to the PE group. The short-term effective rate was significantly higher in the DPMAS+PE group (75.0% vs. 44.0%, P = 0.008). The DPMAS+PE group also had lower plasma consumption (26.5 vs. 51.0 mL/kg, P = 0.000) and a lower rate of adverse events (3.6% vs. 24.0%, P = 0.026) compared to the PE group. However, there was no statistical difference in the 28-day mortality between the two groups (21.4% vs. 40.0%, P > 0.05).
Both DPMAS+half-dose PE and full-dose PE demonstrated improvements in liver function in PALF patients. DPMAS+half-dose PE showed the additional advantage of significantly reducing plasma consumption without significant adverse effects compared to full-dose PE. Thus, DPMAS+half-dose PE may be considered a viable alternative method for PALF treatment, particularly in situations with limited blood supply.
Source: journals.lww.com/jpgn/Abstract/2023/06000/Combination_of_Plasma_Exchange_and_Adsorption.5.aspx
