This retrospective cohort study assessed the efficacy and safety of the Artificial Liver Support System (ALSS) in patients with severe drug-induced liver injury (DILI).

A total of 185 patients with severe DILI were enrolled and divided into two groups: the ALSS group and the Standard Medication Therapy (SMT) group. The study evaluated improvements in biochemical indicators and 90-day survival rates.

The ALSS group demonstrated significant reductions in total bilirubin, direct bilirubin, and alanine transaminase (ALT) levels after treatment and at 4 weeks post-treatment. In the drug-induced liver failure subgroup, baseline hepatic encephalopathy prevalence and MELD scores were significantly higher in the ALSS group (χ² = 9.918, P = 0.002; t-test P = 0.014). Kaplan-Meier analysis revealed significantly lower survival in the ALSS group (χ² = 4.869, P = 0.027). Multivariate Cox analysis identified hepatic encephalopathy as an independent risk factor for 90-day survival (HR = 2.091, 95% CI [1.048–4.170], P = 0.036). In the cholestatic subgroup, no significant survival difference was observed (χ² = 0.345, P = 0.557). Pre-treatment platelet count (PLT) was correlated with survival (HR = 0.984, 95% CI [0.969–1.000], P = 0.049).

ALSS improves short-term liver function in severe DILI patients, but baseline hepatic encephalopathy and platelet levels are critical factors influencing long-term outcomes.