Abstract: Objective The aim of this study was to investigate the short-term efficacy of sequential plasma exchange (PE) and dual plasma molecular adsorption system (DPMAS) combination in treatment of patients with hepatitis B virus infection-related acute-on-chronic liver failure (HBV-ACLF). Methods A retrospective analysis was performed on the clinical data of 64 patients with HBV-ACLF admitted to First Affiliated Hospital, Army Medical University and the 923rd Hospital, People's Liberation Army, between May 2018 and May 2020. Out of them, 33 patients received PE and 31 patients received PE and sequential DPMAS treatment. All patients were follow-up for 90 days. The survival rates in the two groups were statistically analyzed by Kaplan-Meier method. Results At the end of day 28 and day 90, total serum bilirubin levels in PE-DPMAS-treated patients were (119.5±19.4)μmol/L and (29.5±10.4)μmol/L, significantly lower than [(149.5±30.5)μmol/L and (52.4±15.9)μmol/L, respectively, P＜0.05] in patients receiving PE; at the end of 90 day treatment, serum c-reactive protein, procalcitonin and interleukin-6 levels were(12.6±3.5)mg/L,(0.5±0.2)ng/L and (13.4±2.7)ng/L, significantly lower than [(19.2±3.3)mg/L, (0.7±0.4)ng/L and (18.2±3.5)ng/L, respectively, P＜0.05] in patients receiving PE alone; at the end of 90 days, the survival rate in patients receiving PE-DPMAS treatment was 83.9%, significantly higher than 57.6% in PE-treated patients (P＜0.05). Conclusion The sequential therapy with PE and DPMAS could improve liver function tests, decrease serum inflammatory factors and elevate the 90 day survivals in patients with HBV-ACLF.

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