Intensive Care Medicine (2019)
Alshamsi and co-authors performed a systematic review and
meta-analysis of randomized controlled trials (RCT) to examine the efficacy and
safety of extracorporeal liver support (ECLS) in patients with liver failure [1].
ECLS can be divided into artificial (cell-free systems) and bioartificial liver
support devices that incorporate hepatocytes in an artificial device. The
authors identified 25 RCTs including 1796 patients, and used the GRADE approach
to assess the certainty of evidence. Thirteen RCTs assessed patients with acute
liver failure (ALF) and 13 RCTs investigated patients with acute-on-chronic
liver failure (ACLF). Nineteen trials used artificial ECLS and five trials used
bio-artificial ECLS. The authors observed a significant association of ECLS and
reduction in mortality (RR 0.84, 95% CI 0.74–0.96, moderate certainty) and significant
improvement in hepatic encephalopathy (RR 0.71, 95% CI 0.60–0.84, low
certainty) in patients with ALF and ACLF. Subgroup analysis did not observe a
difference of outcome using ECLS in patients with ALF and ACLF. Furthermore,
kind of device, risk of bias and funding source did not reveal significant
subgroup differences. Additional sensitivity analysis excluding four studies
published in abstract form revealed similar results. The number needed to treat
was 22 in patients with ALF and 16 in patients with ACLF. In summary, this
systematic review and meta-analysis provides evidence that ECLS may reduce
mortality in patients with ALF and ACLF. This effect was more prominent with
artificial than with bio-artificial devices.
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