Prognostic value of Inflammatory Cytokine Levels (TNF-α, procalcitonin (PCT), interferon gamma (IFN-γ), IL-2, IL-6, and IL-10), Clinical Efficacy, and Prognosis of Hybrid Artificial Liver Support System in the Treatment of Chronic Liver Failure

Prognostic value of Inflammatory Cytokine Levels

  • Xueping Nan Department of Gastroenterology, Xi 'an International Medical Center Hospital, Xi'an 710100, Shaanxi Province, China
Keywords: TNF-α, procalcitonin (PCT), interferon gamma (IFN-γ), IL-2, IL-6, and IL-10 ,CLF; PE; DPMAS; adverse reactions; long-term survival

Abstract


Introduction: it aimed to explore effectiveness and security of the hybrid artificial liver support system (HALSS) for chronic liver failure (CLF) patients, and analyze inflammatory response and prognosis of patients.

Material and Method: 126 patients with CLF divided into plasma exchange group (PEG), double plasma molecular absorb system group (DPMASG), and combination group (CG). Liver and kidney function, blood coagulation function, and T lymphocyte subgroup level change were compared, analysis of short-term clinical curative effect and adverse reactions after treatment.

Result: as against PEG and DPMASG, in CG, peripheral blood alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil), total biliary acid, creatinine (Cr),international normalized ratio (INR), prothrombin time (PT) dropped and cholinesterase (ChE), albumin, prothrombin time activity (PTA) rose; peripheral blood CD4+ rose, CD8+ dropped, and inflammatory cytokine TNF-α, procalcitonin (PCT), interferon gamma (IFN-γ), IL-2, IL-6, and IL-10 levels were lower; model for end-stage liver disease (MELD) and Child-Turcotte-Pugh (CTP) score were lower (all P < 0.05). In PEG, DPMASG, and CG, the clinical total effective rate was 76.3%, 78.9%, and 92.0%, respectively; the adverse reaction rate (ARR) was 18.4%, 13.2%, and 8.0%; 1-year overall survival rate (SR) for follow-up was 18.4%, 21.1%, and 36.0%. CG had higher clinical effectiveness and 1-year overall survival, and lower rate of adverse reaction (P < 0.05).

Conclusion: PE+DPMAS can effectively improve the CLF, liver and kidney function, and blood coagulation function in patients.

References

Abbas, N., Rajoriya, N., Elsharkawy, A.M., and Chauhan, A., 2022. Acute-on-chronic liver failure (ACLF) in 2022: have novel treatment paradigms already arrived?. Expert Rev. Gastroenterol. Hepatol., 16(7): 639-652. https://doi.org/10.1080/17474124.2022.2097070
Casulleras, M., Zhang, I.W., López-Vicario, C., and Clària, J., 2020. Leukocytes, systemic inflammation and immunopathology in acute-on-chronic liver failure. Cells., 9(12): 2632. https://doi.org/10.3390/cells9122632
Chowdhry, M., Sharma, A., Agrawal, S., Vohra, R., Kumar, K., Goyal, N., Kumar, V.A., Jerath, N., Malhotra, S., Sibal, A., and Mishra, M., 2023. Efficacy of therapeutic plasma exchange in pediatric cases of acute liver failure as an extracorporeal liver support system. Transfus. Apher. Sci., 62(6): 103835. https://doi.org/10.1016/j.transci.2023.103835
Chris-Olaiya, A., Kapoor, A., Ricci, K.S., and Lindenmeyer, C.C., 2021. Therapeutic plasma exchange in liver failure. World J. Hepatol., 13(8): 904-915. https://doi.org/10.4254/wjh.v13.i8.904
Ferstl, P. and Trebicka, J., 2021. Acute decompensation and acute-on-chronic liver failure. Clin. Liver Dis., 25(2): 419-430. https://doi.org/10.1016/j.cld.2021.01.009
Figueira, E.R.R., Rocha-Filho, J.A., Lanchotte, C., Nacif, L.S., de Paiva Haddad, L.B., Assalin, A.R., Shinkado, Y.R., Vintimilla, A.M., Galvao, F.H.F., and D'Albuquerque, L.A.C., 2021. Creatinine-lactate score predicts mortality in non-acetaminophen-induced acute liver failure in patients listed for liver transplantation. BMC Gastroenterol., 21(1): 252. https://doi.org/10.1186/s12876-021-01830-5
Huang, S., Li, Y., Wang, B., Zhou, Z., Li, Y., Shen, L., Cong, J., Han, L., Xiang, X., Xia, J., He, D., Zhao, Z., Zhou, Y., Li, Q., Dai, G., Shen, H., Lin, T., Wu, A., Jia, J., Xiao, D., Li, J., Zhao, W., and Lin, X., 2024. Hepatocyte-specific METTL3 ablation by Alb-iCre mice (GPT), but not by Alb-Cre mice (JAX), resulted in acute liver failure (ALF) and postnatal lethality. Aging (Albany NY), 16(8): 7217-7248. https://doi.org/10.18632/aging.205753
Jia, J.F., Liang, F., Huang, J.W., Wang, H., and Han, P.Q., 2022. Effect of artificial liver with double plasma molecular absorb system model on patients' platelets and corresponding treatment strategy. Beijing Da Xue Xue Bao Yi Xue Ban, 54(3): 548-551. https://doi.org/10.19723/j.issn.1671-167X.2022.03.022
Karvellas, C.J., Francoz, C., and Weiss, E., 2021. Liver transplantation in acute-on-chronic liver failure. Transplantation., 105(7): 1471-1481. https://doi.org/10.1097/TP.0000000000003550
Li, R., Mukherjee, M.B., Jin, Z., Liu, H., Lin, K., Liu, Q., Dilger, J.P., and Lin, J., 2023. The potential effect of general anesthetics in cancer surgery: meta-analysis of postoperative metastasis and inflammatory cytokines. Cancers (Basel)., 15(10): 2759. https://doi.org/10.3390/cancers15102759
Liu, J., Shi, X., Xu, H., Tian, Y., Ren, C., Li, J., Shan, S., and Liu, S., 2023. A multi-subgroup predictive model based on clinical parameters and laboratory biomarkers to predict in-hospital outcomes of plasma exchange-centered artificial liver treatment in patients with hepatitis B virus-related acute-on-chronic liver failure. Front. Cell. Infect. Microbiol., 13: 1107351. https://doi.org/10.3389/fcimb.2023.1107351
Maiwall, R., Bajpai, M., Singh, A., Agarwal, T., Kumar, G., Bharadwaj, A., Nautiyal, N., Tevethia, H., Jagdish, R.K., Vijayaraghavan, R., Choudhury, A., Mathur, R.P., Hidam, A., Pati, N.T., Sharma, M.K., Kumar, A., and Sarin, S.K., 2022. Standard-volume plasma exchange improves outcomes in patients with acute liver failure: a randomized controlled trial. Clin. Gastroenterol. Hepatol., 20(4): e831-e854. https://doi.org/10.1016/j.cgh.2021.01.036
Mechler, K. and Liantonio, J., 2019. Palliative care approach to chronic diseases: end stages of heart failure, chronic obstructive pulmonary disease, liver failure, and renal failure. Prim. Care., 46(3): 415-432. https://doi.org/10.1016/j.pop.2019.05.008
Mukit, A.A., Mahtab, M.A., Rahim, M.A., Noor-E-Alam, S.M., Das, D.C., Moben, A.L., Khondaker, F.A., Alam, M.A., Begum, R., Haque, M.E., Islam, M.A., Mamun, A.A., and Akbar, S.M.F., 2022. Plasma exchange in patients of acute on chronic liver failure: an observational study in bangladesh. Euroasian J. Hepatogastroenterol., 12(1): 1-5. https://doi.org/10.5005/jp-journals-10018-1354
Nagy, Á., Holndonner-Kirst, E., Eke, C., Kertai, M.D., Fazekas, L., Benke, K., Pólos, M., Szabolcs, Z., Hartyánszky, I., Gál, J., Merkely, B., and Székely, A., 2020. Model for end-stage liver disease scores in veno-arterial extracorporeal membrane oxygenation. Int. J. Artif. Organs., 43(10): 684-691. https://doi.org/10.1177/0391398820906538
Ocak, I., 2023. Value of extracorporeal artificial liver support in pediatric acute liver failure: A single-center experience of over 10 years. Front. Pediatr., 11 :979619. https://doi.org/10.3389/fped.2023.979619
Ou, L., Liu, H.R., Shi, X.Y., Peng, C., Zou, Y.J., Jia, J.W., Li, H., Zhu, Z.X., Wang, Y.H., Su, B.M., Lai, Y.Q., Chen, M.Y., Zhu, W.X., Feng, Z., Zhang, G.M., and Yao, M.C., 2024. Terminalia chebula Retz. aqueous extract inhibits the Helicobacter pylori-induced inflammatory response by regulating the inflammasome signaling and ER-stress pathway. J. Ethnopharmacol., 320: 117428. https://doi.org/10.1016/j.jep.2023.117428
Pirimoğlu, B., Sade, R., Polat, G., İşlek, A., and Kantarcı, M., 2020. Analysis of correlation between liver fat fraction and AST and ALT levels in overweight and obese children by using new magnetic resonance imaging technique. Turk. J. Gastroenterol., 31(2): 156-162. https://doi.org/10.5152/tjg.2020.18594
Popescu, M., David, C., Marcu, A., Olita, M.R., Mihaila, M., and Tomescu, D., 2023. Artificial liver support with cytosorb and mars in liver failure: a retrospective propensity matched analysis. J. Clin. Med., 12(6): 2258. https://doi.org/10.3390/jcm12062258
Price, J.R., Hagrass, H., Filip, A.B., and McGill, M.R., 2023. LDH and the MELD-LDH in severe acute liver injury and acute liver failure: preliminary confirmation of a novel prognostic score for risk stratification. J. Appl. Lab. Med., 8(3): 504-513. https://doi.org/10.1093/jalm/jfac137
Ramavath, N.N., Gadipudi, L.L., Provera, A., Gigliotti, L.C., Boggio, E., Bozzola, C., Albano, E., Dianzani, U., and Sutti, S., 2021. Inducible T-Cell costimulator mediates lymphocyte/macrophage interactions during liver repair. Front. Immunol., 12: 786680. https://doi.org/10.3389/fimmu.2021.786680
Ruf, A., Dirchwolf, M., and Freeman, R.B., 2022. From child-pugh to MELD score and beyond: Taking a walk down memory lane. Ann. Hepatol., 27(1): 100535. https://doi.org/10.1016/j.aohep.2021.100535
Saliba, F., Bañares, R., Larsen, F.S., Wilmer, A., Parés, A., Mitzner, S., Stange, J., Fuhrmann, V., Gilg, S., Hassanein, T., Samuel, D., Torner, J., and Jaber, S., 2022. Artificial liver support in patients with liver failure: a modified DELPHI consensus of international experts. Intensive Care Med., 48(10): 1352-1367. https://doi.org/10.1007/s00134-022-06802-1
Schulz, M.S., Gu, W., Schnitzbauer, A.A., and Trebicka, J., 2022. Liver transplantation as a cornerstone treatment for acute-on-chronic liver failure. Transpl. Int., 35: 10108. https://doi.org/10.3389/ti.2022.10108
Skidmore, Z.L., Kunisaki, J., Lin, Y., Cotto, K.C., Barnell, E.K., Hundal, J., Krysiak, K., Magrini, V., Trani, L., Walker, J.R., Fulton, R., Brunt, E.M., Miller, C.A., Wilson, R.K., Mardis, E.R., Griffith, M., Chapman, W., and Griffith, O.L., 2022. Genomic and transcriptomic somatic alterations of hepatocellular carcinoma in non-cirrhotic livers. Cancer Genet., 264-265: 90-99. https://doi.org/10.1016/j.cancergen.2022.04.002
Song, Z., Xie, Q., Zhou, Y., Song, S., Gao, Z., Lan, Y., Wu, Z., Cai, H., Yu, D., Liu, C., Liang, J., Xie, B., and Sun, S., 2023. Effect of artificial liver support systems on gut microbiota in patients with HBV-related acute-on-chronic liver failure. Pathogens., 12(9): 1094. https://doi.org/10.3390/pathogens12091094
Squires, J.E., Alonso, E.M., Ibrahim, S.H., Kasper, V., Kehar, M., Martinez, M., Squires, and R.H., 2022. North american society for pediatric gastroenterology, hepatology, and nutrition position paper on the diagnosis and management of pediatric acute liver failure. J. Pediatr. Gastroenterol. Nutr., 74(1): 138-158. https://doi.org/10.1097/MPG.0000000000003268
Tang, L., Wang, X., Zhao, R., Chen, X., Wang, F., Xia, S., Xiao, Q., Zhao, Q., Yang, S., and Tan, S., 2023. Yi-Qi-Jian-Pi formula ameliorates immune function in acute-on-chronic liver failure by upregulating autophagy and mitochondrial biogenesis in CD8+ T lymphocytes. J. Ethnopharmacol., 308: 116276. https://doi.org/10.1016/j.jep.2023.116276
Vento, S. and Cainelli, F., 2023. Acute liver failure in low-income and middle-income countries. Lancet Gastroenterol. Hepatol., 8(11): 1035-1045. https://doi.org/10.1016/S2468-1253(23)00142-5
Wang, F., Sun, W., Xiao, Q., Liang, C., Jiang, S., Lian, Y., Shao, J., Tan, S., and Zheng, S., 2021. Peripheral T lymphocytes predict the severity and prognosis in patients with HBV-related acute-on-chronic liver failure. Medicine (Baltimore), 100(5): e24075. https://doi.org/10.1097/MD.0000000000024075
Wang, Y., Zhang, H., Chen, Q., Jiao, F., Shi, C., Pei, M., Lv, J., Zhang, H., Wang, L., and Gong, Z., 2020. TNF-α/HMGB1 inflammation signalling pathway regulates pyroptosis during liver failure and acute kidney injury. Cell. Prolif., 53(6): e12829. https://doi.org/10.1111/cpr.12829
Xu, Y., Wang, J., Ren, H., Dai, H., Zhou, Y., Ren, X., Wang, Y., Feng, S., Deng, X., Wu, J., Fu, T., Nie, T., He, H., Wei, T., Zhu, B., Hui, L., Li, B., Wang, J., Wang, H., Chen, L., Shi, X., and Cheng, X., 2023. Human endoderm stem cells reverse inflammation-related acute liver failure through cystatin SN-mediated inhibition of interferon signaling. Cell. Res., 33(2): 147-164. https://doi.org/10.1038/s41422-022-00760-5
Yang, C.F., Zhang, Z., Zhang, X.Y., and Li, Y.M., 2021. Artificial liver support system in pediatric acute liver failure due to mushroom poisoning: Case series. Ann. Hepatol., 23: 100290. https://doi.org/10.1016/j.aohep.2020.100290
Yao, J., Li, S., Zhou, L., Luo, L., Yuan, L., Duan, Z., Xu, J., and Chen, Y., 2019. Therapeutic effect of double plasma molecular adsorption system and sequential half-dose plasma exchange in patients with HBV-related acute-on-chronic liver failure. J. Clin. Apher., 34(4): 392-398. https://doi.org/10.1002/jca.21690
Published
2025/05/09
Section
Original paper