Efficacy and Safety of Double Plasma Molecular Adsorption System at Different Therapeutic Doses During Regional Citrate Anticoagulation: A Pilot Study

This study aimed to assess the safety and therapeutic efficacy of increasing the dosage of the double plasma molecular adsorption system (DPMAS) in patients with liver failure during regional citrate anticoagulation (RCA). A prospective nonrandomized controlled trial was conducted. Three groups (3 L group, 4.5 L group, and 6 L group) of patients with liver failure receiving DPMAS treatment were created on the basis of various therapeutic plasma volumes. A total of 303 patients were included, with 110 in the 3 L group, 121 in the 4.5 L group, and 72 in the 6 L group. At the end of treatment, there was a statistically significant difference in the bilirubin clearance rate among the groups (H = 15.239, p < 0.001). Pairwise comparisons revealed that only the difference in the bilirubin clearance rates between the 6 L group and the 3 L group was statistically significant (p < 0.001). With the exception of base excess, no statistically significant differences were found between these three groups for any of the relevant laboratory indicators (p > 0.05). The incidence of hypotension, hypocalcemia, acidosis, alkalosis, hypernatremia, hyperlactatemia, and allergic reactions did not differ significantly among these three groups (p > 0.05). Furthermore, a statistically significant difference was found in clotting events among these three groups (p = 0.027), with a higher incidence observed in the 6 L group than in the 3 L group (p = 0.011). Increasing the therapeutic dose of RCA-DPMAS further removed bilirubin and did not increase the complications associated with citrate anticoagulation, but the coagulation risk is a concern.