To Assess the Efficacy of High-Volume Plasma Exchange and GCSF Versus GCSF Alone in Patients of Acute on Chronic Liver Failure (ACLF).
Acute-On-Chronic Liver Failure
About this trial
This is an interventional treatment trial for Acute-On-Chronic Liver Failure
Eligibility Criteria
Inclusion Criteria:
- All consecutive patients in age group of 18-70 years with acute on chronic liver failure as defined by APASL criteria shall be included in the study.Only those patients who wish to be enrolled in the trial shall be included in the study.
Exclusion Criteria:
- Steroid eligible patients with severe alcoholic hepatitis
- Cirrhosis of liver with previous history of decompensation
- Patients with severe cardiopulmonary disease
- Pregnancy
- Human Immmunodeficiency Virus infection
- Hepatocellular carcinoma or extrahepatic malignancy
- Chronic renal insufficiency on treatment with haemodialysis
- Uncontrolled bleed or patients in disseminated intravascular coagulopathy
- Patient with expected survival of less than 48 hours
- Patients with moderate-severe acute respiratory distress syndrome
- Hemodynamic instability with noradrenaline requirement of more than >0.5ug/kg/min or requirement of dual vasopressors
- Patients with leukemoid reaction or total leucocyte count > 40,000/mm3
- Patients diagnosed with Hemophagocytic Lymphohistiocytosis
- Patients with known hypersensitivity to Granulocyte colony stimulating factor
Sites / Locations
- Institute of Liver and Biliary Sciences
Arms of the Study
Arm 1
Arm 2
Arm 3
Active Comparator
Experimental
Experimental
Standard Medical Therapy
Standard Medical Therapy + Plasma exchange + GCSF
Standard Medical Therapy + GCSF
The patients in group A will be given standard medical therapy only as per requirement. Lactulose, bowel wash, albumin, terlipressin, antibiotics and anti-virals in hepatitis B reactivation will be continued and recorded.
The patients in group B shall be given GCSF in a dose of 5 ug/kg/day on day 1,2,3,4,5 followed by every 3rd day till day 28 along with alternate day high volume plasma exchange sessions till a maximum of ten sessions.
The patients in this will be given standard medical therapy only as per requirement. Lactulose, bowel wash, albumin, terlipressin, antibiotics and anti-virals in hepatitis B reactivation will be continued and recorded. The GCSF in a dose of 5 ug/kg/day on day 1,2,3,4,5 followed by every 3rd day till day 28