Abstract: Objective The aim of this study was to compare the efficacy of plasma exchange (PE) and hemofiltration (HF) at different start-up time in the treatment of patients with acute-on-chronic hepatitis B liver failure (HBV-ACLF). Methods 126 patients with HBV-ACLF were enrolled in our hospital between March 2021 and March 2024, and all patients underwent PE/HF therapy. Artificial liver supporting system (ALSS) treatment started early (less than 72 hours after admission) in 89 cases (observation), and started lately (72 hours thereafter) in 37 cases (control). Results ALSS carried out repeatedly for (3.4±1.4)times in the observation group, much less than [(4.6±1.1)times, P<0.05] in the control, while 28-day and 90 day survivals were 84.2% and 67.4%, much higher than 67.6% and 48.6%(P<0.05) in the control; by three months after treatment, serum HBV DNA went to negative in all the patients in the two groups; there were no significant differences as respect to serum potassium, sodium and chlorine levels before and after ALSS treatment in the two groups(P>0.05); after treatment, total serum bilirubin level, prothrombin time activity and serum albumin level in 60 survivals in the observation group were (25.8±7.6)μmol/L, (68.2±9.3)% and (34.7±2.8)g/L, not significantly different as compared to [(28.4±5.9)μmol/L, (63.7±8.6)% and (35.6±2.5)g/L, respectively, P<0.05] in 18 survivals in the control group. Conclusion ALSS treatment should start as early as possible after admission in patients with ACLF, and any delay and hesitancy might decrease successful rescue rate.

Key words: Acute-on-chronic liver failure;Plasma exchange, hemofiltration, Therapy