Extracorporeal liver support in patients with liver failure: a systematic review and meta-analysis of randomized trials.

Autor: Alshamsi F; Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, PO Box 17666, Al Ain, United Arab Emirates., Alshammari K; Department of Internal Medicine, Al Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia., Belley-Cote E; Division of Critical Care, Department of Medicine, McMaster University, Hamilton, ON, L8S 4K1, Canada.; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, L8S 4K1, Canada., Dionne J; Division of Critical Care, Department of Medicine, McMaster University, Hamilton, ON, L8S 4K1, Canada.; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, L8S 4K1, Canada., Albrahim T; Department of Anesthesiology and Critical Care Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia., Albudoor B; Department of Critical Care Medicine, Shaikh Khalifa Medical City, Abu Dhabi, United Arab Emirates., Ismail M; Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia., Al-Judaibi B; Transplant Hepatology, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, USA, 14642., Baw B; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, L8S 4K1, Canada.; Department of Medicine, McMaster University, Hamilton, ON, L8S 4K1, Canada., Subramanian RM; Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.; Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA., Steadman R; Department of Anesthesiology and Perioperative Medicine, Ronald Reagan Medical Center, University of California Los Angeles, Los Angeles, USA., Galusca D; Department of Anesthesiology, Henry Ford Hospital, Detroit, MI, USA., Huang DT; Department of Critical Care Medicine, Director Multidisciplinary Acute Care Research Organization (MACRO), University of Pittsburgh Medical Center, Pittsburgh, PA, USA., Nanchal R; Department of Pulmonary, Critical Care and Sleep Medicine, Medical College of Wisconsin, Milwaukee, WI, USA., Al Quraini M; Department of Pulmonary and Critical Care Medicine, King Fahad Medical City, Riyadh, Saudi Arabia., Yuan Y; Department of Medicine, McMaster University, Hamilton, ON, L8S 4K1, Canada., Alhazzani W; Division of Critical Care, Department of Medicine, McMaster University, Hamilton, ON, L8S 4K1, Canada. alhazzaw@mcmaster.ca.; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, L8S 4K1, Canada. alhazzaw@mcmaster.ca.
Jazyk: angličtina
Zdroj: Intensive care medicine [Intensive Care Med] 2020 Jan; Vol. 46 (1), pp. 1-16. Date of Electronic Publication: 2019 Oct 07.
DOI: 10.1007/s00134-019-05783-y
Abstrakt: Purpose: Acute liver failure (ALF) and acute on chronic liver failure (ACLF) are associated with significant mortality and morbidity. Extracorporeal liver support (ECLS) devices have been used as a bridge to liver transplant; however, the efficacy and safety of ECLS are unclear. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to examine the efficacy and safety of ECLS in liver failure.
Methods: We searched MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials from inception through March 13, 2019. RCTs comparing ECLS to usual care in ALF or ACLF were included. We used the Grading of Recommendations Assessment, Development and Evaluation approach to assess the certainty of the evidence.
Results: We identified 25 RCTs (1796 patients). ECLS use was associated with reduction in mortality (RR 0.84; 95% CI 0.74, 0.96, moderate certainty) and improvement in hepatic encephalopathy (HE) (RR 0.71; 95% CI 0.60, 0.84, low certainty) in patients with ALF or ACLF. The effect of ECLS on hypotension (RR 1.46; 95% CI 0.98, 2.2, low certainty), bleeding (RR 1.21; 95% CI 0.88, 1.66, moderate certainty), thrombocytopenia (RR 1.62; 95% CI 1.0, 2.64, very low certainty) and line infection (RR 1.92; 95% CI 0.11, 33.44, low certainty) was uncertain.
Conclusions: ECLS may reduce mortality and improve HE in patients with ALF and ACLF. The effect on other outcomes is uncertain. However, the evidence is limited by risk of bias and imprecision, and larger trials are needed to better determine the effect of ECLS on patient-important outcomes.
Databáze: MEDLINE
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