Supplementary Material for: Meta-analysis of Influencing Factors of Mortality in Chinese Patients with Liver Failure Undergoing Plasma Exchange

Objective: This meta-analysis aimed to evaluate the determinants that influence mortality of individuals with liver failure who are undergoing the treatment of plasma exchange (PE).
Materials and Methods: The search for relevant literature was conducted from the beginning of the database records up to January 5, 2024, encompassing a range of databases such as PubMed, Embase, the Cochrane Library, Web of Science, as well as Chinese databases including CNKI (China National Knowledge Infrastructure), WanFang, and VIP. For the analysis of continuous variables, the weighted mean difference (WMD) was utilized, while for categorical variables, the odds ratio (OR) was employed. Both statistical measures were presented alongside their respective 95% confidence intervals (CI). Subgroup analyses were conducted based on liver failure type, volume of plasma exchanged, and HBV etiology.
Results: In total, 33 studies involving 5,842 patients were included. Older age, a higher MELD score, the presence of HE, cirrhosis, HRS, and peritonitis, elevated AST levels, low ALB level, low PTA, prolonged PT, low PLT, and WBC counts were associated with mortality in Chinese patients with liver failure who underwent PE (all P< 0.05). However, these influencing factors could vary depending on the type of liver failure and the exchange volume during PE.
Conclusion: Several demographic indicators, liver function indicators, coagulation indicators, and routine blood are associated with mortality in patients with liver failure undergoing PE. This study may provide important clinical guidance for the care of patients with liver failure, helping to improve patient survival.

目的：本项荟萃分析旨在评估影响接受血浆置换（plasma exchange, PE）治疗的肝衰竭患者死亡率的相关决定因素。
材料与方法：本研究检索了各数据库自建库起始至2024年1月5日的相关文献，涵盖PubMed、Embase、Cochrane图书馆、Web of Science等外文数据库，以及中国知网（China National Knowledge Infrastructure, CNKI）、万方、维普等中文数据库。针对连续变量的统计分析采用加权均数差（weighted mean difference, WMD），分类变量则采用比值比（odds ratio, OR），两类统计量均同步报告其95%置信区间（confidence interval, CI）。此外，本研究基于肝衰竭分型、血浆置换体积及乙型肝炎病毒（hepatitis B virus, HBV）病因学开展了亚组分析。
结果：本研究共纳入33项相关研究，涉及5842例患者。在接受PE治疗的中国肝衰竭患者中，高龄、较高的终末期肝病模型（model for end-stage liver disease, MELD）评分、合并肝性脑病（hepatic encephalopathy, HE）、肝硬化、肝肾综合征（hepatorenal syndrome, HRS）及腹膜炎、天冬氨酸氨基转移酶（aspartate aminotransferase, AST）水平升高、白蛋白（albumin, ALB）水平降低、凝血酶原活动度（prothrombin activity, PTA）降低、凝血酶原时间（prothrombin time, PT）延长、血小板计数（platelet, PLT）及白细胞计数（white blood cell, WBC）降低均与患者死亡率升高显著相关（所有P<0.05）。不过，上述影响因素可因肝衰竭分型及PE治疗中的血浆置换量不同而存在差异。
结论：多项人口统计学指标、肝功能指标、凝血功能指标及血常规指标与接受PE治疗的肝衰竭患者死亡率密切相关。本研究可为肝衰竭患者的临床诊疗提供重要参考，助力改善患者的生存预后。