Efficacy of DPMAS combined with PE in improving survival outcomes of patients with acute hepatitis E-induced liver failure: A retrospective cohort analysis.

BACKGROUND AND AIMS: Acute hepatitis E can progress to liver failure with high mortality and limited treatment options. This study aimed to evaluate the clinical efficacy and safety of the Double Plasma Molecular Adsorption System (DPMAS) combined with plasma exchange (PE) in individuals with acute hepatitis E-induced liver failure. METHODS: A retrospective analysis was performed on hospitalized patients with acute hepatitis E-induced liver failure admitted from January 2011 to December 2023. Ninety-three patients were enrolled and assigned to either a control group (n = 36), receiving standard medical therapy, or a treatment group (n = 57), receiving artificial liver support therapy with DPMAS combined with PE. Liver function parameters, coagulation indices, Model for End-Stage Liver Disease (MELD) scores, and survival rates were compared. Adverse reactions in the treatment group were recorded and evaluated. RESULTS: The treatment group demonstrated significantly greater improvement in liver function and coagulation parameters than the control group. MELD score reduction was more pronounced in the treatment group (-6.78 ± 2.45 vs. -2.59 ± 1.98, p < 0.001). The 6-month survival rate was also higher (87.7% vs. 80.5%, p = 0.038). Cox regression identified age ≥60 years (HR = 2.15), liver cirrhosis (HR = 2.41), infection (HR = 3.15), hepatic encephalopathy (HR = 2.87), ascites (HR = 1.94), and international normalized ratio (INR) ≥1.5 (HR = 2.54) as independent risk factors for poor prognosis, while higher serum albumin level (HR = 0.49) and DPMAS combined with PE (HR = 0.47) were protective. A total of eight adverse reactions were mild and infrequent, including transient hypotension (5.3%) and mild allergic reactions (8.8%), and resolved with symptomatic treatment without interrupting therapy. CONCLUSION: DPMAS combined with PE is a safe and effective therapeutic modality for acute hepatitis E-induced liver failure, improving liver function, reducing MELD scores, and enhancing survival outcomes. MELD score may serve as a valuable tool to guide treatment stratification and predict prognosis.