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- W4289816122 abstract "Background and Aim: Low volume plasma exchange (PLEX) with low dose steroid improves 1-year survival in severe alcoholic hepatitis (SAH) patients. Methods: We retrospectively analyzed data in SAH patients (DF >32) admitted to our unit between November 2017 to September 2021. PLEX was performed after informed consent. Patients unwilling for PLEX got standard medical treatment (SMT). Type of PLEX (centrifugal or membrane) was decided on a case-to-case basis, patients after September 2020 mostly underwent centrifugal PLEX (c.PLEX). PLEX patients received oral prednisolone (10 mg daily, 1 month). Results: Of 109 SAH patients [all males, age: 42 (23-66) years; median, range, serum bilirubin: 24.2 (4.6-53.6) mg%, MELD: 31 (20-58), DF: 88.3 (46.7- 425.9); plasma von Willebrand factor: 732 (187-1486) U/dl], 33 patients underwent c.PLEX, 23 underwent membrane PLEX (m. PLEX) and 53 had SMT. Baseline characteristics were similar in the both PLEX groups. Patients in SMT group had higher MELD score at admission (p-0.005). PLEX parameters were similar in c.PLEX [sessions: 3 (1-7); exchange per session: 1.4 (1.2-1.6) liters] and m.PLEX [sessions:3 (1-5); exchange:1.4 (0.5-1.5)liters]. Plasma removal efficiency was higher in c.PLEX [56 (43-87)%] as compared to m.PLEX [20(10-40)%] (p-value <0.00001) and flow rate was slower [35 (25-50) ml/min, 125 (100-150) ml/min respectively] (p<0.00001). During 1-year follow up, 78 patients died, 29 were alive and 2 had liver transplantation. One-year transplant-free survival estimate (standard error) was significantly better in c.PLEX group: 54.6% (9.2) compared to m.PLEX: 5.2% (5) and SMT: 18.1% (5.4). Hazard ratio (HR) of c.PLEX compared to m.PLEX was 0.25 (0.12-0.53) and adjusted HR of c.PLEX compared to SMT was 0.35 (0.19-0.64). Conclusions: SAH patients treated with c.PLEX had better 1 year survival compared to m.PLEX or SMT. We suggest centrifugal PLEX as the preferred type of PLEX (with low dose steroid) to treat SAH patients." @default.
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- W4289816122 date "2022-01-01" @default.
- W4289816122 modified "2023-09-26" @default.
- W4289816122 title "Therapeutic plasma exchange by centrifugal technique has survival benefit at 1-year, over membranous technique in patients with severe alcoholic hepatitis" @default.
- W4289816122 doi "https://doi.org/10.1016/j.jceh.2022.07.052" @default.
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