Citation

Ninan A, Mohan G, Shanbhag V, Chenna D, Shastry S, Rao S. J. Clin. Apher. 2024; 39(3): e22110.

Copyright

(Copyright © 2024, John Wiley and Sons)

DOI

10.1002/jca.22110

PMID

38634432

Abstract

BACKGROUND: Acute liver failure (ALF) following yellow phosphorous (YP) ingestion is similar to acetaminophen-induced ALF and it has become a public concern in our region. This study assessed low volume therapeutic plasma exchange (LV-TPE) efficacy in improving the transplant free survival in YP poisoning.

METHODS: Adult patients with toxicology reports of YP and ALF requiring critical care were included in the study. LV-TPE was planned for three consecutive days and three more if required. Performed 1.3 to 1.5 plasma volume replacing with 0.9% normal saline, 5% human albumin solution, and fresh frozen plasma based on ASFA 2019 criteria. MELD score, laboratory parameters, LV-TPE details were captured. The study end point was clinical outcome of the patients.

RESULTS: Among 36 patients, 19 underwent LV-TPE and 17 opted out of LV-TPE and they were included as a control arm. The MELD score was 32.64 ± 8.05 and 37.83 ± 9.37 in both groups. There were 13 survivors in LV-TPE group leading to a 68.42% reduction in mortality. The coagulation and biochemical parameters showed a significant percentage change after LV-TPE. Refractory shock, delay in initiating procedure and acidosis were independent predictors of mortality.

CONCLUSION: A well-timed LV-TPE improves the survival of patients with ALF due to YP poisoning.

Language: en

Keywords

*Liver Failure, Acute/therapy; *Plasma Exchange/methods; acute liver failure; Adult; Humans; liver transplant; low volume therapeutic plasma exchange; plasma exchange; rodenticide; Treatment Outcome; yellow phosphorous poisoning