{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T06:56:28Z","timestamp":1773039388969,"version":"3.50.1"},"reference-count":33,"publisher":"Wiley","license":[{"start":{"date-parts":[[2018,1,1]],"date-time":"2018-01-01T00:00:00Z","timestamp":1514764800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Research Project of Sichuan Provincial Health and Family Planning Commission","award":["16PJ279"],"award-info":[{"award-number":["16PJ279"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Canadian Journal of Gastroenterology and Hepatology"],"published-print":{"date-parts":[[2018]]},"abstract":"Aim<\/jats:italic>. To assess the tolerance of citrate accumulation due to plasma exchange (PE) among patients with acute-on-chronic liver failure (ACLF). Methods<\/jats:italic>. A prospective, observational study was conducted among patients with ACLF who received heparin anticoagulation during PE-centered therapy without filtration and dialysis. Citrate accumulation was defined as the value of total calcium (C<\/mml:mi>a<\/mml:mi><\/mml:mrow>t<\/mml:mi>o<\/mml:mi>t<\/mml:mi><\/mml:mrow><\/mml:msub><\/mml:mrow><\/mml:math>) to ionized calcium (C<\/mml:mi>a<\/mml:mi><\/mml:mrow>i<\/mml:mi>o<\/mml:mi>n<\/mml:mi><\/mml:mrow><\/mml:msub><\/mml:mrow><\/mml:math>) ratio (C<\/mml:mi>a<\/mml:mi><\/mml:mrow>t<\/mml:mi>o<\/mml:mi>t<\/mml:mi><\/mml:mrow><\/mml:msub>\/<\/mml:mo>C<\/mml:mi>a<\/mml:mi><\/mml:mrow>i<\/mml:mi>o<\/mml:mi>n<\/mml:mi><\/mml:mrow><\/mml:msub><\/mml:math>) greater than or equal to 2.5 (C<\/mml:mi>a<\/mml:mi><\/mml:mrow>t<\/mml:mi>o<\/mml:mi>t<\/mml:mi><\/mml:mrow><\/mml:msub>\/<\/mml:mo>C<\/mml:mi>a<\/mml:mi><\/mml:mrow>i<\/mml:mi>o<\/mml:mi>n<\/mml:mi><\/mml:mrow><\/mml:msub>\u2265<\/mml:mo>2<\/mml:mn>.<\/mml:mo>5<\/mml:mn><\/mml:math>). Results<\/jats:italic>. Fifty-four patients were enrolled. The mean age and MELD score were 50.0 \u00b1 11.3 years old and 25 \u00b1 7, respectively. Thirty-three patients had liver cirrhosis. The total 3-month survival rate was 57.4% (31\/54). The mean C<\/mml:mi>a<\/mml:mi><\/mml:mrow>t<\/mml:mi>o<\/mml:mi>t<\/mml:mi><\/mml:mrow><\/mml:msub>\/<\/mml:mo>C<\/mml:mi>a<\/mml:mi><\/mml:mrow>i<\/mml:mi>o<\/mml:mi>n<\/mml:mi><\/mml:mrow><\/mml:msub><\/mml:math> at the time before PE was 2.05 \u00b1 0.14. C<\/mml:mi>a<\/mml:mi><\/mml:mrow>t<\/mml:mi>o<\/mml:mi>t<\/mml:mi><\/mml:mrow><\/mml:msub>\/<\/mml:mo>C<\/mml:mi>a<\/mml:mi><\/mml:mrow>i<\/mml:mi>o<\/mml:mi>n<\/mml:mi><\/mml:mrow><\/mml:msub>\u2265<\/mml:mo>2.5<\/mml:mn><\/mml:math> occurred in 100.0% (54\/54) and 29.6% (16\/54) of patients with mean C<\/mml:mi>a<\/mml:mi><\/mml:mrow>t<\/mml:mi>o<\/mml:mi>t<\/mml:mi><\/mml:mrow><\/mml:msub>\/<\/mml:mo>C<\/mml:mi>a<\/mml:mi><\/mml:mrow>i<\/mml:mi>o<\/mml:mi>n<\/mml:mi><\/mml:mrow><\/mml:msub><\/mml:math> of 4.34 \u00b1 1.52 and 2.36 \u00b1 0.32 immediately after PE and 1 hour after PE, respectively, and these levels were much higher than those before PE (p<\/mml:mi><<\/mml:mo>0.01<\/mml:mn><\/mml:math>). However, all values returned to lower than 2.5 by the next morning with no difference from those before PE (2.10 \u00b1 0.14 versus 2.05 \u00b1 0.14, p<\/mml:mi>><\/mml:mo>0.05<\/mml:mn><\/mml:math>). Hypocalcemia (ionized calcium) and mild alkalosis were the main metabolic alterations. No symptoms associated with hypocalcemia occurred. Conclusions<\/jats:italic>. Citrate accumulation is well tolerated by patients with ACLF who receive PE-centered therapy without filtration and dialysis. This study is regeristed with ChiCTR-OOC-17013618<\/jats:ext-link>.<\/jats:p>","DOI":"10.1155\/2018\/4909742","type":"journal-article","created":{"date-parts":[[2018,4,18]],"date-time":"2018-04-18T19:40:52Z","timestamp":1524080452000},"page":"1-10","source":"Crossref","is-referenced-by-count":11,"title":["Good Tolerance of Citrate Accumulation due to Plasma Exchange among Patients with Acute-on-Chronic Liver Failure: A Prospective, Observational Study"],"prefix":"10.1155","volume":"2018","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1025-6080","authenticated-orcid":true,"given":"Yuanji","family":"Ma","sequence":"first","affiliation":[{"name":"Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu 610041, China"},{"name":"Division of Infectious Diseases, State Key Laboratory of Biotherapy, Sichuan University, Chengdu 610041, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7953-6737","authenticated-orcid":true,"given":"Yan","family":"Xu","sequence":"additional","affiliation":[{"name":"Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu 610041, China"},{"name":"Division of Infectious Diseases, State Key Laboratory of Biotherapy, Sichuan University, Chengdu 610041, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3815-3542","authenticated-orcid":true,"given":"Fang","family":"Chen","sequence":"additional","affiliation":[{"name":"Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu 610041, China"},{"name":"Division of Infectious Diseases, State Key Laboratory of Biotherapy, Sichuan University, Chengdu 610041, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7325-3488","authenticated-orcid":true,"given":"Ying","family":"Wang","sequence":"additional","affiliation":[{"name":"Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu 610041, China"},{"name":"Division of Infectious Diseases, State Key Laboratory of Biotherapy, Sichuan University, Chengdu 610041, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5042-4336","authenticated-orcid":true,"given":"Lang","family":"Bai","sequence":"additional","affiliation":[{"name":"Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu 610041, China"},{"name":"Division of Infectious Diseases, State Key Laboratory of Biotherapy, Sichuan University, Chengdu 610041, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3912-2067","authenticated-orcid":true,"given":"Hong","family":"Tang","sequence":"additional","affiliation":[{"name":"Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu 610041, China"},{"name":"Division of Infectious Diseases, State Key Laboratory of Biotherapy, Sichuan University, Chengdu 610041, 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