Hypotension among patients with liver failure treated by artificial liver support system: risk factors and coping strategies

BACKGROUND: Artificial Liver Support System (ALSS) is a core therapeutic modality for liver failure, but hypotension is a common and severe complication during treatment, which may lead to treatment interruption and poor prognosis. This study aims to explore the independent risk factors of hypotension complicating ALSS treatment for liver failure, construct a predictive model, and provide evidence for clinical coping strategies. METHODS: A retrospective cohort study was conducted. According to the occurrence of hypotension during treatment, they were divided into the hypotension group and the non-hypotension group. Clinical data of the two groups were collected and analyzed. RESULTS: 216 patients with liver failure who received ALSS treatment were included. Multivariate logistic regression analysis confirmed that age ≥ 65 years (OR = 2.379, 95%CI:1.568 ~ 3.605), BMI < 19 kg/m² (OR = 2.782, 95%CI:1.825 ~ 4.226), ALSS treatment duration > 4 h (OR = 2.598, 95%CI:1.689 ~ 3.987), hypokalemia (OR = 2.193, 95%CI:1.452 ~ 3.298) and hypoalbuminemia (OR = 3.099, 95%CI:2.015 ~ 4.756) were independent risk factors for hypotension (all P < 0.001). The constructed scoring predictive model had excellent discriminative efficacy with an AUC of 0.888 (95%CI:0.840 ~ 0.936), and the highest Youden's index (0.642) was obtained when the scoring threshold was 6.5 points. CONCLUSION: The simplified scoring model exhibits favorable predictive efficacy, enabling early identification and risk stratification of high-risk patients. Implementation of multidimensional prevention strategies-including precision treatment optimization, individualized nursing interventions, and integrated process management-may reduce the incidence of hypotension and improve treatment safety.