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07.10.2019 | Systematic Review

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

verfasst von: Fayez Alshamsi, Khalil Alshammari, Emilie Belley-Cote, Joanna Dionne, Talal Albrahim, Budoor Albudoor, Mona Ismail, Bandar Al-judaibi, Bandar Baw, Ram M. Subramanian, Randolph Steadman, Dragos Galusca, David T. Huang, Rahul Nanchal, Mustafa Al Quraini, Yuhong Yuan, Waleed Alhazzani, The GUIDE Group

Erschienen in: Intensive Care Medicine | Ausgabe 1/2020

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Abstract

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.

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Titel: Extracorporeal liver support in patients with liver failure: a systematic review and meta-analysis of randomized trials
verfasst von: Fayez Alshamsi
Khalil Alshammari
Emilie Belley-Cote
Joanna Dionne
Talal Albrahim
Budoor Albudoor
Mona Ismail
Bandar Al-judaibi
Bandar Baw
Ram M. Subramanian
Randolph Steadman
Dragos Galusca
David T. Huang
Rahul Nanchal
Mustafa Al Quraini
Yuhong Yuan
Waleed Alhazzani
The GUIDE Group
Publikationsdatum: 07.10.2019
Verlag: Springer Berlin Heidelberg
Erschienen in: Intensive Care Medicine / Ausgabe 1/2020
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-019-05783-y

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