Abstract：
OBJECTIVE: Plasma exchange (PLEX) improves survival in patients with rodenticidal hepatotoxicity. However, predictors of treatment response are unknown. We aimed at assessing predictors of response to PLEX treatment in these patients.
METHODS: Patients with rodenticidal hepatotoxicity from 2014 to 2023 managed in our department were included in this study. Kochi criteria (model for end-stage liver disease [MELD] score ≥ 36 or international normalized ratio [INR] ≥ 6 with hepatic encephalopathy [HE]) derived specifically for rodenticidal hepatotoxicity (PubMed IDentifier [PMID]: 26310868) were used to assess need for liver transplantation. We analyzed predictors of survival at one month. ∆Bilirubin, ∆MELD score and ∆INR were calculated as percentage change of the parameter after third PLEX session (or after last PLEX if < 3 PLEX sessions done) from baseline pre-PLEX value.
RESULTS: Of 200 patients with rodenticidal hepatotoxicity, 114 patients were treated with low-volume PLEX (PLEX-LV). No patient had liver transplantation. Of 78 patients who fulfilled Kochi criteria, 32 patients were PLEX-LV eligible and underwent PLEX-LV (M: 10; age: 20.5, 7-70 years; median, range; acute liver failure: 24). Twenty-two (69%; acute liver failure: 14) of the 32 patients were alive at one month. Presence of HE (p = 0.03) and ∆MELD (p < 0.001) were significant predictors on univariate analysis, while ∆MELD (aOR = 0.88, 95% CI: 0.79-0.98, p = 0.01) was the only significant independent predictor of one-month transplant-free survival. Area under receiver operating characteristic (ROC) for ∆MELD was 0.93 (95% CI:0.85-1.00) and a decrease of ≥ 20% in MELD score while on PLEX-LV had 90% sensitivity and 90% specificity in predicting one-month survival.
CONCLUSIONS: Decline in MELD while on PLEX-LV independently predicted one-month transplant-free survival in rodenticidal hepatotoxicity patients. This may help guide decision on stopping PLEX-LV in patients predicted to respond to treatment and to consider alternate treatment options in non-responders.
METHODS: Patients with rodenticidal hepatotoxicity from 2014 to 2023 managed in our department were included in this study. Kochi criteria (model for end-stage liver disease [MELD] score ≥ 36 or international normalized ratio [INR] ≥ 6 with hepatic encephalopathy [HE]) derived specifically for rodenticidal hepatotoxicity (PubMed IDentifier [PMID]: 26310868) were used to assess need for liver transplantation. We analyzed predictors of survival at one month. ∆Bilirubin, ∆MELD score and ∆INR were calculated as percentage change of the parameter after third PLEX session (or after last PLEX if < 3 PLEX sessions done) from baseline pre-PLEX value.
RESULTS: Of 200 patients with rodenticidal hepatotoxicity, 114 patients were treated with low-volume PLEX (PLEX-LV). No patient had liver transplantation. Of 78 patients who fulfilled Kochi criteria, 32 patients were PLEX-LV eligible and underwent PLEX-LV (M: 10; age: 20.5, 7-70 years; median, range; acute liver failure: 24). Twenty-two (69%; acute liver failure: 14) of the 32 patients were alive at one month. Presence of HE (p = 0.03) and ∆MELD (p < 0.001) were significant predictors on univariate analysis, while ∆MELD (aOR = 0.88, 95% CI: 0.79-0.98, p = 0.01) was the only significant independent predictor of one-month transplant-free survival. Area under receiver operating characteristic (ROC) for ∆MELD was 0.93 (95% CI:0.85-1.00) and a decrease of ≥ 20% in MELD score while on PLEX-LV had 90% sensitivity and 90% specificity in predicting one-month survival.
CONCLUSIONS: Decline in MELD while on PLEX-LV independently predicted one-month transplant-free survival in rodenticidal hepatotoxicity patients. This may help guide decision on stopping PLEX-LV in patients predicted to respond to treatment and to consider alternate treatment options in non-responders.
摘要：
目的：血浆置换（PLEX）可提高杀虫性肝毒性患者的生存率。然而,治疗反应的预测因素未知.我们旨在评估这些患者对PLEX治疗反应的预测因子。
方法：本研究纳入了2014年至2023年在我们部门管理的灭鼠性肝毒性患者。Kochi标准（终末期肝病模型[MELD]评分≥36或国际标准化比率[INR]≥6伴肝性脑病[HE]）专门针对灭鼠性肝毒性（PubMedIDentifier[PMID]：26310868）用于评估肝移植的需要。我们分析了一个月生存率的预测因素。Δ胆红素，在第3次PLEX治疗后(或在第3次PLEX治疗后,如果<3次PLEX治疗,则在最后一次PLEX治疗后)计算参数相对于基线PLEX前值的百分比变化。
结果：在200例灭鼠性肝毒性患者中，114例患者接受低容量PLEX（PLEX-LV）治疗。没有患者进行肝移植。在符合高知标准的78名患者中，32例患者符合PLEX-LV标准，并接受了PLEX-LV（M：10；年龄：20.5，7-70岁；中位数，范围；急性肝功能衰竭：24）。32例患者中有22例（69％；急性肝功能衰竭：14）在一个月时还活着。HE（p=0.03）和ΔMELD（p<0.001）的存在是单变量分析的重要预测因子，而ΔMELD（aOR=0.88，95％CI：0.79-0.98，p=0.01）是一个月无移植生存的唯一有意义的独立预测因子。ΔMELD的受试者工作特征下面积（ROC）为0.93（95％CI：0.85-1.00），MELD评分降低≥20％，而PLEX-LV在预测一个月生存率方面具有90％的敏感性和90％的特异性。
结论：使用PLEX-LV时MELD下降独立预测了杀虫性肝毒性患者一个月的无移植生存率。这可能有助于指导预测对治疗有反应的患者停止PLEX-LV的决定，并在无反应者中考虑替代治疗方案。
方法：本研究纳入了2014年至2023年在我们部门管理的灭鼠性肝毒性患者。Kochi标准（终末期肝病模型[MELD]评分≥36或国际标准化比率[INR]≥6伴肝性脑病[HE]）专门针对灭鼠性肝毒性（PubMedIDentifier[PMID]：26310868）用于评估肝移植的需要。我们分析了一个月生存率的预测因素。Δ胆红素，在第3次PLEX治疗后(或在第3次PLEX治疗后,如果<3次PLEX治疗,则在最后一次PLEX治疗后)计算参数相对于基线PLEX前值的百分比变化。
结果：在200例灭鼠性肝毒性患者中，114例患者接受低容量PLEX（PLEX-LV）治疗。没有患者进行肝移植。在符合高知标准的78名患者中，32例患者符合PLEX-LV标准，并接受了PLEX-LV（M：10；年龄：20.5，7-70岁；中位数，范围；急性肝功能衰竭：24）。32例患者中有22例（69％；急性肝功能衰竭：14）在一个月时还活着。HE（p=0.03）和ΔMELD（p<0.001）的存在是单变量分析的重要预测因子，而ΔMELD（aOR=0.88，95％CI：0.79-0.98，p=0.01）是一个月无移植生存的唯一有意义的独立预测因子。ΔMELD的受试者工作特征下面积（ROC）为0.93（95％CI：0.85-1.00），MELD评分降低≥20％，而PLEX-LV在预测一个月生存率方面具有90％的敏感性和90％的特异性。
结论：使用PLEX-LV时MELD下降独立预测了杀虫性肝毒性患者一个月的无移植生存率。这可能有助于指导预测对治疗有反应的患者停止PLEX-LV的决定，并在无反应者中考虑替代治疗方案。
