Efficacy and Safety of Cytokine Adsorption and Plasma Exchange in Patients With ACLF and Sepsis

Inclusion criteria

• Age between 18 and 70 years with a background of chronic liver disease, regardless of the presence of cirrhosis.
• Total bilirubin (TBIL) > 12 mg/dL.
• International normalized ratio (INR) ≥ 1.5.
• Meeting the diagnostic criteria for sepsis: confirmed or suspected infection, with a sequential organ failure assessment (SOFA) score increase of ≥ 2 points. (5) High inflammatory status: IL-6 > 80 pg/ml.

(6) Diagnosis of sepsis within the past 72 hours.

Exclusion criteria

• Inherited metabolic liver disease (including Wilson's disease, hereditary hemochromatosis, and alpha-1 antitrypsin deficiency).
• Patients with hepatocellular carcinoma or other malignancies.
• Pregnant or breastfeeding women.
• Patients with human immunodeficiency virus (HIV) infection or other immunodeficiency diseases (including active hematological malignancies, congenital immunodeficiency syndromes, or those currently receiving high-dose systemic immunosuppressive therapy).
• Unstable phase of cerebrovascular events.
• History of organ transplantation.
• Patients with irreversible or terminal extrahepatic organ failure that precludes safe extracorporeal circulation or confounds the intervention: ①Terminal chronic obstructive pulmonary disease, terminal cor pulmonale, brain death, or persistent vegetative state, or Grade IV hepatic encephalopathy. ②Requirement for renal replacement therapy (RRT) at the time of screening/enrollment. ③Despite adequate fluid resuscitation, vasopressors, and steroid treatment, unable to maintain mean arterial pressure above 65 mmHg.
• Platelet count < 50×10E9/L, severe coagulation disorders (INR>3.5), or active bleeding.
• Known allergies to extracorporeal circulation, hemoperfusion, or other severe allergic history.
• Refusal by the patient or their legally authorized representative (LAR) to participate in the study, or sign the informed consent form.
• Inability to return for regular follow-up visits as planned in the study.
• Other conditions that, in the judgment of the researchers, make the patient unsuitable for enrollment.