In alcohol-related acute on chronic liver failure survival after plasma exchange and low-dose steroid is associated with improvement in nutritional parameters and quality of life
Nagabhushana Amruthavarshini, Gayathiri Kaduveti Chellaiya, Santhosh E Kumar, Dolly Daniel, Vinoi George David, Suceena Alexander, Santosh Varughese, Nitin Kapoor, Sunderraj Gnanadeepam, Sumathy Jayaraman, Babuji Manimegalai, Kausala Sithamparapillai, Uday George Zachariah, Chundamannil E Eapen, Ashwani K Singal, Ashish GoelAbstract
Aims
Plasma exchange (PLEX) and low-dose steroid improve survival in alcohol-related acute on chronic liver failure (A-ACLF) patients. In this study, we aimed to objectively assess its effect on nutritional parameters and quality of life (QoL) in survivors.
Methods
Alcohol-related ACLF (as defined by Asia Pacific Association of Study of Liver) patients treated with PLEX and low-dose steroid (August 2023–May 2025) were serially assessed prospectively for nutritional status, anthropometry, sarcopenia, frailty, and QoL. Centrifugal low-volume PLEX, with low-dose steroid was done as per protocol (PMID: 37975044).
Results
Forty-eight A-ACLF patients [males: 48; age: 40 (27–68) years; median (range); discriminant function: 103 (43–206); MELD score: 31 (22–50)] treated with PLEX and low-dose steroids were studied. At baseline, all 48 patients had malnutrition (severe: 15, moderate: 27, mild: 6), the majority had sarcopenia (38 patients, 79%), were frail [42 patients, 87.5%; liver frailty index (LFI): 4.9 (4.3–6.7)], and had poor QoL [Chronic Liver Disease Questionnaire (CLDQ): 3.4 (2.6–4.3)].
On follow-up (3–6 months, n = 25), there was improvement in nutritional parameters—nutrition status [moderate–severe impaired nutrition: 19 patients (76%) to 9 (36%), P-value < .02]; hand grip strength [19.4 (7.6–31) kg to 21.5 (8.7–31.3) kg, P-value .012]; muscle mass [skeletal muscle index: 6.3 (2.7–7.4) to 6.9 (4.2–8.8), P-value .05]; severe sarcopenia [20 (80%) to 7 (28%), P-value .001]; frailty [LFI: 4.7 (4.3–6.1) to 4.5 (3.5–6.6), P-value < .001]; QoL [CLDQ: 3.5 (2.6–4.4) to 5.7 (3.5–6.8), P-value <.001]; and MELD: 30 (23–43) to 17 (7–30); P-value: .05; at baseline and at follow-up, respectively. ACLF reversal was observed in 9/25 (36%) patients.
Conclusions
In A-ACLF patients, survival after PLEX and low-dose steroid is associated with improvement in nutritional parameters and QoL.