What about liver failure?

*For medical professionals to read and reference the combined application of human albumin and artificial liver Albumin Jun: "Liver failure is severe liver damage caused by a variety of factors, resulting in serious dysfunction of the body's synthesis, detoxification, metabolism and biotransformation or Decompensation, and a group of clinical syndromes mainly manifested by jaundice, coagulation dysfunction, hepatorenal syndrome, hepatic encephalopathy, ascites, etc.
, the mortality rate is as high as 60% to 80%[1-3 ]
.

, The main cause of liver failure is hepatitis virus, especially hepatitis B virus (HBV), followed by drugs and hepatotoxic substances (such as alcohol, chemical agents, etc.
), and liver failure in children can also be seen in genetic metabolic diseases [1] "
The
mortality rate of patients with liver failure is so high, how should we deal with it in clinical practice? Artificial liver support system is an important means of liver failure treatment.
Currently, the clinical treatment methods for liver failure include: comprehensive medical treatment, artificial liver support system (ALSS, artificial liver for short) and liver transplantation.
The most effective treatment method is liver transplantation.
However, due to factors such as liver source, ethics, and high surgical costs, the clinical application of liver transplantation is often limited
.

The role of comprehensive medical treatment is relatively weak, the effect is often not obvious
.

Therefore, artificial liver has become the main treatment method for patients with liver failure today, and it can also gain time for patients waiting for liver transplantation to obtain a suitable liver source[3]
.

The artificial liver support system uses in vitro biological and physical and chemical devices to remove various metabolites produced or accumulated during liver failure, replenish essential substances such as proteins that need to be synthesized by the liver, and improve the patient's internal environment such as water, electrolyte and acid-base balance, thereby assisting A treatment for conditions such as liver failure
.

Artificial liver is divided into non-biological type, biological type and mixed type.
At present, non-biological artificial liver has been widely used in clinic and has been proved to have certain curative effect[1]
.

Recommendations for the application of artificial liver support system in the treatment of liver failure in the guide , Non-biological artificial liver treatment indications include: 1.
Patients with early and mid-stage liver failure caused by various reasons, with prothrombin activity (PTA) between 20% and 40%; 2.
Liver transplantation for end-stage liver disease 3.
Patients with severe cholestatic liver disease with poor response to medical drug treatment, severe hyperbilirubinemia caused by various reasons
.

 2.
The "Guidelines for the Diagnosis and Treatment of Liver Failure (2018 Edition)" [1], co-authored by the Liver Failure and Artificial Liver Group of the Chinese Society of Infectious Diseases and the Severe Liver Disease and Artificial Liver Group of the Chinese Society of Hepatology The application of the support system in the treatment of liver failure makes the following recommendations: 1.
Treatment should be based on different etiologies, among which: (1) Drug-induced liver injury: acute liver failure suspected due to acetaminophen (APAP) poisoning: applicable N-acetylcysteine ​​treatment, and artificial liver treatment if necessary; (2) Liver failure caused by acute fatty liver of pregnancy or HELLP syndrome: It is recommended to terminate the pregnancy immediately.
If the condition continues to progress after termination of pregnancy, it is necessary to Consider artificial liver and liver transplantation; (3) Liver failure caused by hepatolenticular degeneration: artificial liver support therapy using plasma exchange, albumin dialysis, hemofiltration, and a combination of various blood purification methods can be used in a relatively short period of time.
2.
Treatment of complications: Artificial liver support therapy should also be used in patients with liver failure combined with cerebral edema or hepatic encephalopathy
.

 In this guideline, the indications for non-bioartificial liver support therapy are the same as those in the Guideline for the Treatment of Liver Failure with Non-bioartificial Liver (2016) compiled by the Liver Failure and Artificial Hepatology Group of the Infectious Diseases Branch of the Chinese Medical Association above
.

The guide recommends the use of human albumin for artificial liver therapy in patients with liver failure.
It is recommended in the "Chinese Rapid Recommendation Guidelines for the Use of Albumin in the Treatment of Liver Cirrhosis (2018 Edition)" [4]: ​​Human albumin can be used for ALSS in patients with liver failure (2B)
.

Evidence for the guideline's recommendation comes from a systematic review (meta-analysis) showing that in patients with liver failure requiring artificial liver support, hemofiltration, albumin-free hemofiltration in dialysate, Compared with hemodialysis and other systems, the use of molecular adsorption recirculation system (MARS) containing albumin in dialysate and component plasma separation adsorption system can significantly reduce its total bilirubin level and slightly reduce its all-cause mortality [5]
.

The guideline states: MARS and component plasma separation adsorption system containing 10%-20% human albumin in conventional dialysate can be used for artificial liver support therapy in patients with liver failure [4]
.

Summary Liver failure is a serious liver damage caused by a variety of factors, and its fatality rate is extremely high, reaching 60% to 80%.
Artificial liver support system is an important means of liver failure treatment
.

Guidelines suggest that ALSS should be used in combination with liver failure when relevant indications are met [1-3]
.

In addition, the use of MARS and component plasma separation adsorption system containing albumin in the dialysate can significantly reduce total bilirubin levels and slightly reduce all-cause mortality in patients with liver failure and needing artificial liver support [5]
.

References: [1] Liver Failure and Artificial Liver Group of Infectious Diseases Branch of Chinese Medical Association, Severe Liver Disease and Artificial Liver Group of Chinese Medical Association Hepatology Branch.
Guidelines for Diagnosis and Treatment of Liver Failure (2018 Edition) [J].
Clinical Hepatobiliary Diseases Journal, 2019, 35(01)_38-44.
[2] Liver Failure and Artificial Liver Group of Infectious Diseases Branch of Chinese Medical Association.
Guidelines for the treatment of liver failure with non-biological artificial livers (2016 edition) [J].
Chinese Clinical Infections Journal of Diseases, 2016, 9(2) : 97 - 103.
[3] Wang Zhichun, Sun Xiu, Zhang Yaqin, Wang Qinying.
Current status and research progress of artificial liver system in the treatment of liver failure [J].
Chinese Clinical Research, 2019,32( 09)_1292-1294+1298.
[4] Li Huibo, et al.
Interpretation of "Quick Recommendation Guidelines for the Treatment of Liver Cirrhosis with Human Albumin" [J].
Journal of Clinical Drug Therapy, 2018, 16(12): 10-16 .
[5]Tsipotis E, Shuja A, Jaber BL.
Albumin Dialysis for Liver Failure: A Systematic Review.
Adv Chronic Kidney Dis.
2015 Sep;22(5):382-90.
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