Multidisciplinary Tumor Board Documentation: Assessing its Frequency, Quality, and Impact.

Acute‐on‐chronic liver failure (ACLF) is one of the most severe forms of liver dysfunction caused by various factors, and its short‐term mortality rate ranges from 20% to approximately 80% []. Hepatitis B virus (HBV)‐related acute‐on‐chronic liver failure (HBV‐ACLF) is the most common type of ACLF in China []. The main manifestations of ACLF include extreme fatigue, obvious digestive tract symptoms, increased bilirubin level, bleeding tendency, as well as hepatic encephalopathy (HE) and ascites []. At present, there is still a lack of specific and effective treatment for HBV‐ACLF. The available treatment options mainly include comprehensive internal medicine treatment (treatment based on the cause and trigger, organ protection treatment, and treatment for complications), artificial liver support system (ALSS) treatment, and liver transplantation (LT) []. However, LT is often not feasible due to various extra‐hepatic factors, such as worsening infections, bleeding, multiple organ failure, and the difficulty in obtaining donated livers in time [, ]. ALSS therapies, which mimic hepatic functions in vitro and partially clear inflammatory factors and neutralize harmful metabolites temporarily, are promising strategies in the management of ACLF []. Currently, ALSS can be classified into nonbiological, biological, and mixed types ALSS [, ]. However, biological ALSS has not been widely used in daily clinical practice due to mixed clinical data and concerns about cell sources []. The ALSS includes various modes. Currently, the modes commonly used in clinical practice mainly include plasma exchange (PE), plasma or blood perfusion, bilirubin adsorption, hemofiltration, hemodialysis, and other traditional methods []. PE is a relatively safe and mature technique that separates the patient's blood and replenishes fresh frozen plasma alone or in combination with albumin []. PE demonstrated a reduction in short‐term mortality in sepsis, which shares similar immune pathogenesis with ACLF, including multiple organ dysfunction and systemic inflammation []. Systematic reviews and meta‐analyses have shown that PE may help improve the overall survival rate of patients with ACLF []. The double plasma molecular adsorption system (DPMAS) is a relatively new blood purification technology that has been applied in clinical practice in China in recent years. This system, by using bilirubin adsorption columns and blood perfusion devices, is capable of removing more medium and large‐molecular toxins, bilirubin, and inflammatory factors []. However, an undeniable side effect of DPMARS is its impact on the patient's blood coagulation function accompanied by the clearance of multiple harmful substances during treatment []. Based on the respective advantages and disadvantages of PE and DPMAS, the combined application of PE and DPMAS in the study of ACLF has become one of the hot topics in the field of liver failure research. As expected, a large amount of positive data has emerged in scientific research. The combined application of PE and DPMAS has shown significant effects in the following aspects: (1) It reduces the amount of plasma used and saves medical resources such as blood products []. (2) The combination of PE and DPMAS can significantly improve liver function, coagulation function, and blood indicators of patients with acute liver failure, and also increase the effectiveness of treatment []. (3) DPMAS + PE treatment was associated with significantly higher 28‐day effectiveness and 90‐day LT‐free survival in a subgroup of patients (prothrombin time activity [PTA] > 40%) and had advantages of better cost‐effectiveness []. However, the reported conclusions are not always completely consistent []. A randomized controlled trial of Prometheus, a system with a similar design to DPMAS, did not improve survival probability except in the most severe patients with MELD scores > 30 []. Therefore, the European Association for the Study of the Liver (EASL) Clinical Practice Guidelines (2018) do not recommend ALSS for the treatment of ACLF []. Why has the same medical technology been controversial for such a long time? Since ALSS is not a continuous operation, do different inter‐treatment intervals of ALSS treatments lead to different clinical effects? This study conducted a retrospective analysis, aiming to compare whether there are differences in the clinical efficacy of ALSS treatments using short inter‐treatment interval treatment (SIIT) versus long inter‐treatment interval treatment (LIIT) for HBV‐ACLF, and to identify the possible mechanisms behind this phenomenon, in order to provide theoretical support for clinical decision‐making regarding the use of ALSS for HBV‐ACLF.