Background/aims: Acute on chronic liver failure (AoCLF) is associated with a high mortality rate. Plasma exchange (PE) is useful to bridge AoCLF patients to liver transplantation. The aim of this study was to assess the effects of PE on plasma ammonia levels (PAL) in AoCLF patients.
Methodology: Seventy patients with AoCLF in 2 groups (PE plus standard medical treatment group, n = 32; and standard medical treatment group, n = 38) were enrolled in study. PAL was detected on admission and on days 7, 14, 21, and 30 during hospitalization.
Results: All AoCLF patients showed PAL more than the upper limit of the normal range. More dramatic decreased in the PE survivors (form 116.8 +/- 36.3 to 44.8 +/- 16.3, p < 0.01) than the medical survivors (form 105.7 +/- 30.2 to 57.1 +/- 20.3, p < 0.05) after 30 days of treatment. Furthermore, PAL after medical treatment were still higher than those of PE treatment in the survivors (57.1 +/- 20.3 vs. 44.8 +/- 16.3, p < 0.05). Among the non-survivors in the medical group, PAL remained at high levels throughout the examination period. Importantly, an increased PAL associated with high mortality and reduced survival time of AoCLF patients.
Conclusions: Ammonia may be important in the pathogenesis of the AoCLF and PE may represent a reliable hepatic support device for AoCLF.