Abstract: Objective The prognosis of patients with ACLF is extremely poor with mortality rates ranging from 30% to 70%. Hemoperfusion,plasma exchange（PE） and double plasma molecular absorb system （DPMAS） are the most popular non-biological artificial liver support system applied in China. The present study was to evaluate the effects of PE and sequential DPMAS therapy on short survival in patients with hepatitis B virus-induced acute-on-chronic liver failure （HBV-ACLF）. Method 83 patients at different stages of HBV-ACLF were recruited in Xijing hospital between January 2011 and December 2016. All the laboratory parameters were collected at admission,before and after artificial liver support system therapy,and at the end of 90 day follow up. Result There were 29 cases at early stage,34 cases at middle stage and 20 cases at advanced stage at admission in this series of 83 patients with HBV-ACLF. At the end of 90 days of treatment,the survival rate in patients at early stage was 65.5%,in patients at middle stage was 38.2%,and in patients at advanced stage was 15.0% （P<0.001）;The incidence rates of hepatic encephalopathy in patients at early,middle and advanced stage were 20.7%,52.9% and 60.0% （P<0.05）;Multivariate Logistic regression analysis showed that the advanced stage（P=0.01）,serum bilirubin level being ≥350 μmol/L（P=0.008）,hepatic encephalopathy being≥grade 2（P=0.001） and CLIF-SOFA being≥10（P=0.043） at presentation were the independent risk factors of mortality in patients with HBV ACLF. Conclusion Sequential PE and DPMAS therapy might remove toxin from blood,improve the overall survival rate,and the efficacy is obvious in patients at early and middle stage,which still needs further investigation. Patients at admission have serum bilirubin levels ≥350 μmol/L,with hepatic encephalopathy≥grade 2,CLIF-SOFA scores≥10 and at advanced stage might hint poor prognosis.

Key words: Acute-on-chronic liver failure, Artificial liver support system, Plasma exchange, Double plasma molecular absorb system, Therapy