Abstract: Objective The aim of this study was to investigate the efficacy of dual plasma molecular adsorption system (DPMAS) with sequential half-volume plasma exchange (HPE) in the treatment of patients with hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF). Methods 61 patients with HBV-ACLF were encountered in our hospital between January 2023 and December 2024, and were randomly divided into control (n=31) and observation (n=30) group, receiving conventional supporting treatment or DPMAS with sequential HPE at base of supporting treatment respectively. Serum C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) levels were measured by ELISA. Results By end of four week treatment, total serum bilirubin and international normalized ratio of prothrombin time in the observation group were (73.2±16.2)μmol/L and (1.4±0.2), both significantly lower than [(143.4±31.4)μmol/L and (1.6±0.4), respectively, P<0.05], while serum albumin level was(34.1±2.7)g/L, significantly higher than [(31.9±3.8)g/L, P<0.05] in the control; serum CRP, IL-6 and TNF-α levels were (12.8±3.2)mg/L, (10.2±3.2)pg/L and (105.2±24.5) mg/L, all much lower than [(19.2±4.1)mg/L, (18.5±3.2)pg/L and (143.5±23.7)mg/L, respectively, P<0.05] in the control group; 28 d survival was 93.3% in the observation group, much higher than 83.9%(P<0.05) in the control, while there was no significant difference respect to 90 d survivals (80.0% vs. 77.4%) in the two groups (P>0.05). Conclusion DPMAS with sequential HPE at base of conventional supporting treatment might help patients with HBV-ACLF survive liver failure short-termly, which needs further clinical investigation.

Key words: Acute-on-chronic liver failure, Dual plasma molecular adsorption system, Half-dose plasma exchange, Therapy