Alshamsi, F., Alshammari, K., Belley-Cote, E. et al.
Intensive Care Med (2019).
First online: 07.10.2019
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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