Therapeutic Effects of Plasmapheresis on Acute Exacerbations of Chronic Hepatitis B Infection

Overview

Journal Cureus

Specialty Biomedical Engineering

Date 2021 Feb 25

PMID 33628651

Authors

Yilmaz Bilgic

Sami Akbulut

Ayse Cengiz

Ahmet Sarici

Yasir Cagin

Murat Harputluoglu

Affiliations

Soon will be listed here.

Abstract

Objective In this study, we aimed to demonstrate the effectiveness of plasmapheresis therapy in patients with acute exacerbation of chronic Hepatitis B (CHB) infection. Methods We selected 48 patients with acute exacerbation of CHB infection who were treated by plasmapheresis in our intensive care unit between 2009 and 2016. The patients' demographic characteristics and biochemical and hematological parameters, which were recorded before and after plasmapheresis, were assessed, and the effect of plasmapheresis on the course of patients' treatment was examined. The patients were also divided into three groups according to their clinical course (discharged: 24; transplanted: six; exitus: eight). The patients were further divided into four groups and compared based on the underlying causes that led to the exacerbation (spontaneous exacerbation: 25; caused by immunosuppressive drugs: nine; hepatotoxic drugs: six; other agents: eight). Results We observed significant improvements in terms of international normalized ratio (INR), aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT), lactate dehydrogenase (LDH), total bilirubin, direct bilirubin, blood urea nitrogen (BUN), ammonia, and the Model for End-Stage Liver Disease (MELD) score after plasmapheresis therapy. However, there was no significant improvement in hemoglobin (Hb), white blood cell (WBC) count, platelets, albumin, and lactate values. Also, INR, ALP, and ALT values were found to be significantly correlated with transplants and exitus in patients. Conclusion Plasmapheresis therapy is a reliable treatment method that provides clinical recovery and improvement in laboratory parameters in patients with exacerbation of CHB infection.

References

Kandiah P, Olson J, Subramanian R . Emerging strategies for the treatment of patients with acute hepatic failure. Curr Opin Crit Care. 2016; 22(2):142-51. DOI: 10.1097/MCC.0000000000000291. View

Podoll A, DeGolovine A, Finkel K . Liver support systems--a review. ASAIO J. 2012; 58(5):443-9. DOI: 10.1097/MAT.0b013e31825f3446. View

Lamontagne R, Bagga S, Bouchard M . Hepatitis B virus molecular biology and pathogenesis. Hepatoma Res. 2017; 2:163-186. PMC: 5198785. DOI: 10.20517/2394-5079.2016.05. View

Rozga J . Liver support technology--an update. Xenotransplantation. 2006; 13(5):380-9. DOI: 10.1111/j.1399-3089.2006.00323.x. View

Clemmesen J, Kondrup J, Nielsen L, Larsen F, Ott P . Effects of high-volume plasmapheresis on ammonia, urea, and amino acids in patients with acute liver failure. Am J Gastroenterol. 2001; 96(4):1217-23. DOI: 10.1111/j.1572-0241.2001.03706.x. View

Barton J, Riely C, Adamec T, SHANKLIN D, Khoury A, Sibai B . Hepatic histopathologic condition does not correlate with laboratory abnormalities in HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count). Am J Obstet Gynecol. 1992; 167(6):1538-43. DOI: 10.1016/0002-9378(92)91735-s. View

Mohta S, Soneja M, Vyas S, Khot W . Tuberculosis and Guillain-Barre syndrome: A chance association?. Intractable Rare Dis Res. 2017; 6(1):55-57. PMC: 5359354. DOI: 10.5582/irdr.2016.01073. View

Hadem J, Hafer C, Schneider A, Wiesner O, Beutel G, Fuehner T . Therapeutic plasma exchange as rescue therapy in severe sepsis and septic shock: retrospective observational single-centre study of 23 patients. BMC Anesthesiol. 2014; 14:24. PMC: 3986467. DOI: 10.1186/1471-2253-14-24. View

Li M, Sun J, Li J, Shi Z, Xu J, Lu B . Clinical observation on the treatment of acute liver failure by combined non-biological artificial liver. Exp Ther Med. 2017; 12(6):3873-3876. PMC: 5228520. DOI: 10.3892/etm.2016.3887. View

10.

Laleman W, Wilmer A, Evenepoel P, Verslype C, Fevery J, Nevens F . Review article: non-biological liver support in liver failure. Aliment Pharmacol Ther. 2006; 23(3):351-63. DOI: 10.1111/j.1365-2036.2006.02765.x. View

11.

Rimmer E, Houston B, Kumar A, Abou-Setta A, Friesen C, Marshall J . The efficacy and safety of plasma exchange in patients with sepsis and septic shock: a systematic review and meta-analysis. Crit Care. 2014; 18(6):699. PMC: 4318234. DOI: 10.1186/s13054-014-0699-2. View

12.

Tsai W, Sun W, Cheng J . Chronic Hepatitis B with Spontaneous Severe Acute Exacerbation. Int J Mol Sci. 2015; 16(12):28126-45. PMC: 4691034. DOI: 10.3390/ijms161226087. View

13.

Kao J, Chen P, Lai M, Chen D . Acute exacerbations of chronic hepatitis B are rarely associated with superinfection of hepatitis B virus. Hepatology. 2001; 34(4 Pt 1):817-23. DOI: 10.1053/jhep.2001.28188. View

14.

Tan E, Wang M, Pang J, Lee G . Plasma exchange in patients with acute and acute-on-chronic liver failure: A systematic review. World J Gastroenterol. 2020; 26(2):219-245. PMC: 6962432. DOI: 10.3748/wjg.v26.i2.219. View

15.

van de Kerkhove M, Hoekstra R, Chamuleau R, van Gulik T . Clinical application of bioartificial liver support systems. Ann Surg. 2004; 240(2):216-30. PMC: 1356396. DOI: 10.1097/01.sla.0000132986.75257.19. View

16.

Smith J, Weinstein R, Hillyer K . Therapeutic apheresis: a summary of current indication categories endorsed by the AABB and the American Society for Apheresis. Transfusion. 2003; 43(6):820-2. DOI: 10.1046/j.1537-2995.2003.00397.x. View

17.

Puri P . Acute exacerbation of chronic hepatitis B: the dilemma of differentiation from acute viral hepatitis B. J Clin Exp Hepatol. 2015; 3(4):301-12. PMC: 3940633. DOI: 10.1016/j.jceh.2013.08.014. View

18.

Harry R, Auzinger G, Wendon J . The clinical importance of adrenal insufficiency in acute hepatic dysfunction. Hepatology. 2002; 36(2):395-402. DOI: 10.1053/jhep.2002.34514. View

19.

Padden M . HELLP syndrome: recognition and perinatal management. Am Fam Physician. 1999; 60(3):829-36, 839. View

20.

van Deuren M, Frieling J, van der Ven-Jongekrijg J, Neeleman C, Russel F, van Lier H . Plasma patterns of tumor necrosis factor-alpha (TNF) and TNF soluble receptors during acute meningococcal infections and the effect of plasma exchange. Clin Infect Dis. 1998; 26(4):918-23. DOI: 10.1086/513933. View