Risk factor analysis for hypotension during double plasma molecular adsorption system therapy in hepatic failure patients_West China Medical Journal

Authors：

ZHAO Yuan ¹ , LIN Li ¹ , WANG Fang ¹ , HE Yingying ¹ , TANG Xue ¹ , CHEN Zhiwen ¹ ,  ZHANG Ling ²

1. Department of Nephrology and Institute of Kidney Diseases, West China Hospital, Sichuan University / West China School of Nursing, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Nephrology and Institute of Kidney Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

ZHANG Ling, Email: zhangling_crrt@163.com

Keywords：

Hepatic failure; double plasma molecular adsorption system; hypotension; risk factor

DOI：

10.7507/1002-0179.202506125

Video：

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Objective To investigate the risk factors for hypotension in liver failure patients during double plasma molecular adsorption system (DPMAS) treatment, providing a theoretical basis for targeted clinical prevention and intervention. Methods Liver failure patients undergoing DPMAS at West China Hospital of Sichuan University between March 2021 and March 2023 were retrospectively enrolled. General data and clinical indicators were compared between the hypotension group and non-hypotension group. Multivariate logistic regression analysis was used to identify risk factors for hypotension. Results Of the 403 included patients, 60 (14.89%) developed hypotension, while 343 (85.11%) did not. Univariate analyses showed statistically significant differences between groups in age, sex, body mass index (BMI), albumin, serum sodium, pre-treatment systolic blood pressure, pre-treatment diastolic blood pressure, pre-treatment mean arterial pressure, and intraoperative vasoactive drug use (P<0.05). Multivariate logistic regression revealed that low BMI [odds ratio (OR)=0.712, 95% confidence interval (CI) (0.587, 0.863)], low serum sodium [OR=0.715, 95%CI (0.646, 0.792)], and intraoperative vasoactive drug use [OR=11.382, 95%CI (4.438, 29.194)] were independent risk factors for hypotension (P<0.05). Receiver operating characteristic curve analysis combining these three factors yielded an area under the curve of 0.922 [95%CI (0.886, 0.957)] for predicting hypotension incidence. Conclusions Low serum sodium, intraoperative vasoactive drug use, and low BMI are significant risk factors for hypotension during DPMAS therapy. Clinical emphasis should be placed on anticipating and mitigating hypotension to ensure uninterrupted treatment, reduce economic burdens, and improve patient prognosis.

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24.	孙伟航, 张骜丹, 李巍. 预后营养指数联合磁共振表观扩散系数在肝细胞癌肝动脉化疗栓塞中的临床应用价值. 中华医学杂志, 2019, 99(33): 2581-2585.
25.	余玲, 吕丽敏, 陈亚丹. 临床护士《血管活性药物静脉输注护理》团体标准的执行情况. 中国卫生标准管理, 2023, 14(7): 7-12.

1. 陈香美. 血液净化操作规程. 北京: 人民卫生出版社, 2021: 186-187.
2. 中华医学会肝病学分会重型肝病与人工肝学组. 人工肝血液净化技术临床应用专家共识(2022 年版). 实用肝脏病杂志, 2022, 25(3): 457-468.
3. 中华医学会感染病学分会肝衰竭与人工肝学组, 中华医学会肝病学分会重型肝病与人工肝学组. 肝衰竭诊治指南(2018 年版). 中华肝脏病杂志, 2019, 27(1): 18-26.
4. 中华医学会器官移植学分会围手术期管理学组. 肝衰竭肝移植围手术期管理中国专家共识(2021 版). 中华消化外科杂志, 2021, 20(8): 835-840.
5. Palmer BF, Henrich WL. Recent advances in the prevention and management of intradialytic hypotension. J Am Soc Nephrol, 2008, 19(1): 8-11.
6. McIntyre CW, Goldsmith DJ. Ischemic brain injury in hemodialysis patients: which is more dangerous, hypertension or intradialytic hypotension?. Kidney Int, 2015, 87(6): 1109-1115.
7. 王建华. 实用医学科研方法. 2 版. 北京: 人民卫生出版社, 2003: 56-57.
8. Flythe JE, Xue H, Lynch KE, et al. Association of mortality risk with various definitions of intradialytic hypotension. J Am Soc Nephrol, 2015, 26(3): 724-734.
9. 中华医学会感染病学分会肝衰竭与人工肝学组, 中华医学会肝病学分会重型肝病与人工肝学组. 肝衰竭诊治指南(2024 年版). 临床肝胆病杂志, 2024, 40(12): 2371-2387.
10. Kanbay M, Ertuglu LA, Afsar B, et al. An update review of intradialytic hypotension: concept, risk factors, clinical implications and management. Clin Kidney J, 2020, 13(6): 981-993.
11. Stefánsson BV, Brunelli SM, Cabrera C, et al. Intradialytic hypotension and risk of cardiovascular disease. Clin J Am Soc Nephrol, 2014, 9(12): 2124-2132.
12. Singh AT, Mc Causland FR. Osmolality and blood pressure stability during hemodialysis. Semin Dial, 2017, 30(6): 509-517.
13. Ma S, Xie Z, Zhang H, et al. Characterization of an artificial liver support system-related vasovagal reaction. Biomed Res Int, 2020, 2020: 6313480.
14. Chang TI, Paik J, Greene T, et al. Intradialytic hypotension and vascular access thrombosis. J Am Soc Nephrol, 2011, 22(8): 1526-1533.
15. 刘寻, 王晓菲, 张婷, 等. 血液透析中低血压临床分析. 中国血液净化, 2021, 20(1): 50-53.
16. Pinter J, Smyth B, Stuard S, et al. Effect of dialysate and plasma sodium on mortality in a global historical hemodialysis cohort. J Am Soc Nephrol, 2024, 35(2): 167-176.
17. Kuipers J, Verboom LM, Ipema KJR, et al. The prevalence of intradialytic hypotension in patients on conventional hemodialysis: a systematic review with meta-analysis. Am J Nephrol, 2019, 49(6): 497-506.
18. Arasnezhad M, Namazinia M, Mazlum SR, et al. The effect of ascending- descending ultrafiltration and sodium profiles on blood pressure in hemodialysis patients: a randomized cross-over study. BMC Nephrol, 2024, 25(1): 128.
19. Ettema EM, Kuipers J, van Faassen M, et al. Effect of plasma sodium concentration on blood pressure regulators during hemodialysis: a randomized crossover study. BMC Nephrol, 2018, 19(1): 214.
20. Praharaj DL, Anand AC. Clinical implications, evaluation, and management of hyponatremia in cirrhosis. J Clin Exp Hepatol, 2022, 12(2): 575-594.
21. 黄冬清, 罗珍玉, 黄小知, 等. 中青年体检人群体质量指数与血糖和血脂及血压相关性分析. 临床医药实践, 2022, 31(1): 55-58.
22. Li Y, Wright MD. Patient positioning during a hypotensive episode for adults undergoing hemodialysis: a review of clinical effectiveness and guidelines. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health, 2020.
23. 潘姚佳, 傅方琳, 韩正, 等. 肥胖类型与心血管代谢性共病的关系: 基于不同性别的中年居民. 中国全科医学, 2025, 28(18): 2285-2293.
24. 孙伟航, 张骜丹, 李巍. 预后营养指数联合磁共振表观扩散系数在肝细胞癌肝动脉化疗栓塞中的临床应用价值. 中华医学杂志, 2019, 99(33): 2581-2585.
25. 余玲, 吕丽敏, 陈亚丹. 临床护士《血管活性药物静脉输注护理》团体标准的执行情况. 中国卫生标准管理, 2023, 14(7): 7-12.

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