Abstract: Objective The aim of this study was to investigate the clinical efficacy of plasma exchange (PE) plus sequential dual plasma molecular adsorption system (DPMAS) in the treatment of patients with hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF). Methods 63 patients with HBV-ACLF were enrolled in our hospital between June 2022 and December 2024, and were randomly assigned to receive PE plus sequential DPMAS in 31 cases in group A, or receive DPMAS plus sequential PE in another 32 cases in group B. Serum biochemical parameters and serum prothrombin time (PT) were measured routinely, and international normalized ratio (INR) was calculated. The disease severity was evaluated by chronic liver failure consortium acute-on-chronic liver failure score (CLIF-C ACLF). Results By end of three week treatment, total serum bilirubin level in group B was (121.3±25.6)μmol/L, much lower than [(151.3±31.6)μmol/L, P<0.05] in group A, while there were no significant differences as respect to serum albumin, INR and CLIF-C ACLF scores [(31.2±5.1)g/L, (1.6±0.3) and (43.9±4.1) vs. (30.6±5.2)g/L, (1.6±0.4) and (45.3±4.8), respectively] between the two groups (P>0.05); during PE/DPMAS treatment, the incidences of adverse effects, such as pipeline blockage or clogging, unstable heart beats, hypotension and hypocalcemia between the two groups were not significant different(7.4% vs. 10.0%, P>0.05); the 28-day and 90-day survival rates in group A were 87.1% and 58.1%, both not significant different as compared to 93.8% and 68.8% (P>0.05) in group B. Conclusion Multiple liver-supporting system treatment, no matter which one first, in dealing with patients with HBV-ACLF might be helpful for improving short-term survivals, and needs further clinical investigation.

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