Đặc điểm lâm sàng, cận lâm sàng và một số yếu tố liên quan tỷ lệ tử vong ở bệnh nhân suy gan cấp trên nền bệnh lý gan mạn do vi rút viêm gan B được điều trị lọc thay thế huyết tương

Abstract

Objective: This study intended to describe clinical features, laboratory data and related factors for outcomes of chronic hepatitis B with or without cirrhosis who suffered from liver failure and treated with plasma exchange. Subject and method: The research is a prospective and retrospective descriptive study, that enrolled 70 participants suffering from liver failure related to hepatitis B virus and treated with therapeutic plasma exchange at 108 Military Central Hospital from January 2018 to June 2022. Result: In total, 58/70 (82.9%) of the participants were male and 43/70 (61.4%) of patients were less than 60 years old. All of the patients were fatigue and jaundice. Edema and skin bleeding were 24.3% and 18.6%, respectively. Serum total bilirubin and ammonia increased to 443.6 ± 120.2µmo/L and 108.7 ± 70.4µmo/L, respectively. The decreasing of prothrombin was 34.4 ± 18.7%. The rates of prothrombin < 40%; albumin ≤ 30g/L; NH₃ ≥ 100µg/dL and total bilirubin ≥ 500µmo/L were 71.4%, 48.6%, 42.9% and 28.6%, respectively. The 28-day survival of the chronic hepatitis cases was 10/27 (37.0%) higher than that of the cirrhosis cases 13/43 (30.2%), however, the difference was not statistically significant (p=0.371). A prothrombin less than 40% and an NH₃ over 100µg/L were significantly related to mortality. Conclusion: The most common clinical manifestations were jaundice, edema and skin bleeding. Subclinical data was recorded following decreasing of prothrombin, albumin and increasing of NH₃. Therein, NH₃ and prothrombin were related factors for mortality.