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Annals of Intensive Care
Published in: Annals of Intensive Care 1/2021

01-12-2021 | Hepatic Encephalopathy | Review

Uncertainty in the impact of liver support systems in acute-on-chronic liver failure: a systematic review and network meta-analysis

Authors: Klementina Ocskay, Anna Kanjo, Noémi Gede, Zsolt Szakács, Gabriella Pár, Bálint Erőss, Jan Stange, Steffen Mitzner, Péter Hegyi, Zsolt Molnár

Published in: Annals of Intensive Care | Issue 1/2021

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Abstract

Background

The role of artificial and bioartificial liver support systems in acute-on-chronic liver failure (ACLF) is still controversial. We aimed to perform the first network meta-analysis comparing and ranking different liver support systems and standard medical therapy (SMT) in patients with ACLF.

Methods

The study protocol was registered with PROSPERO (CRD42020155850). A systematic search was conducted in five databases. We conducted a Bayesian network meta-analysis of randomized controlled trials assessing the effect of artificial or bioartificial liver support systems on survival in patients with ACLF. Ranking was performed by calculating the surface under cumulative ranking (SUCRA) curve values. The RoB2 tool and a modified GRADE approach were used for the assessment of the risk of bias and quality of evidence (QE).

Results

In the quantitative synthesis 16 trials were included, using MARS®, Prometheus®, ELAD®, plasma exchange (PE) and BioLogic-DT®. Overall (OS) and transplant-free (TFS) survival were assessed at 1 and 3 months. PE significantly improved 3-month OS compared to SMT (RR 0.74, CrI: 0.6–0.94) and ranked first on the cumulative ranking curves for both OS outcomes (SUCRA: 86% at 3 months; 77% at 1 month) and 3-month TFS (SUCRA: 87%) and second after ELAD for 1-month TFS (SUCRA: 76%). Other comparisons did not reach statistical significance. QE was moderate for PE concerning 1-month OS and both TFS outcomes. Other results were of very low certainty.

Conclusion

PE seems to be the best currently available liver support therapy in ACLF regarding 3-month OS. Based on the low QE, randomized trials are needed to confirm our findings for already existing options and to introduce new devices.
Appendix
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Metadata
Title
Uncertainty in the impact of liver support systems in acute-on-chronic liver failure: a systematic review and network meta-analysis
Authors
Klementina Ocskay
Anna Kanjo
Noémi Gede
Zsolt Szakács
Gabriella Pár
Bálint Erőss
Jan Stange
Steffen Mitzner
Péter Hegyi
Zsolt Molnár
Publication date
01-12-2021
Publisher
Springer International Publishing
Published in
Annals of Intensive Care / Issue 1/2021
Electronic ISSN: 2110-5820
DOI
https://doi.org/10.1186/s13613-020-00795-0

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