RESUMO
ObjectiveTo investigate the efficacy and safety of artificial liver support therapy with an Evanure-4A selective membrane plasma separator and its influence on platelet count in the treatment of patients with acute-on-chronic liver failure （ACLF） patients with different platelet counts. MethodsA total of 302 patients with ACLF who were hospitalized in Department of Hepatology， Chengdu Public Health Clinical Medical Center， from January 2021 to May 2023， were enrolled， and according to the platelet count （PLT）， they were divided into group A （25×109/L — 50×109/L） with 101 patients， group B （51×109/L — 80×109/L） with 98 patients， and group C （81×109/L — 100×109/L） with 103 patients. In addition to medical treatment， all patients received different modes of artificial liver support therapy based on their conditions， including plasma perfusion combined with plasma exchange， double plasma molecular adsorption combined with plasma exchange， and bilirubin system adsorption combined with plasma exchange. The paired t-test was used for comparison of continuous data before and after treatment in each group； an analysis of variance was used for comparison between multiple groups， and the SNK-q test was used for further comparison between two groups； the chi-square test was used for comparison of categorical data between multiple groups. ResultsOf all 302 patients， 268 （88.74%） achieved varying degrees of improvement in clinical symptoms after artificial liver support therapy. After treatment， all three groups had varying degrees of reductions in alanine aminotransferase （t=14.755， 21.614， and 15.965， all P<0.001）， aspartate aminotransferase （t=11.491， 19.301， and 13.919， all P<0.001）， total bilirubin （t=19.182， 17.486， and 21.75， all P<0.001）， and international normalized ratio （INR） （t=3.497， 3.327， and 4.358， all P<0.05）. After artificial liver support therapy with an Evanure-4A selective membrane plasma separator， PLT in group A decreased from （37.73±6.27）×109/L before treatment to （36.59±7.96）×109/L after treatment， PLT in group B decreased from （66.97±7.64）×109/L before treatment to （62.59±7.37）×109/L after treatment， and PLT in group C decreased from （93.82±5.38）×109/L before treatment to （85.99±12.49）×109/L after treatment； groups B and C had significant reductions in PLT after treatment （t=12.993 and 8.240， both P<0.001）， but there was no significant difference in group A （P>0.05）. There was no significant difference in the incidence rate of adverse reactions during artificial liver support therapy between the three groups （P>0.05）. ConclusionArtificial liver support therapy can improve liver function and INR in patients with ACLF. The use of Evaure-4A selective membrane plasma separator during artificial liver support therapy has little influence on platelets， and it is safe in the treatment of ACLF patients with a significantly lower level of platelets.