A More Intensive Regimen of Albumin Dyalisis Improves Survival in Patients with Acute on Chronic Liver Failure. Results from an Individual-Patient Data Meta-Analysis

Background: Acute-on-chronic liver failure (ACLF) is a common complication of cirrhosis characterized by single or multiple organ failures and high short-term mortality. Treatment of ACLF consists of standard medical care (SMC) and organ(s) support. Whether the efficacy of artificial liver support (ALS) depends on the severity of ACLF or on the intensity of this treatment, or both, is unclear. This study aimed to further assess these issues. Methods: We performed an individual patient data meta-analysis assessing the efficacy of Molecular Adsorbent Recirculating System (MARS) in ACLF patients enrolled in prior randomized control trials (RCTs). The meta-analysis was designed to assess the effect of patient severity (ACLF grade) and treatment intensity [low-intensity therapy (LIT), SMC alone or SMC plus ⩽ 4 MARS sessions, high-intensity therapy (HIT), SMC plus > 4 MARS sessions] on mortality. Results: Three RCTs suitable for the meta-analysis ( n = 285, ACLF patients = 165) were identified in a systematic review. SMC plus MARS (irrespective of the number of sessions) did not improve survival compared with SMC alone, neither in the complete population nor in the ACLF patients. Survival, however, was significantly improved in the subgroup of patients receiving HIT both in the entire cohort (10-day survival: 98.6% versus 82.8%, p = 0.001; 30-day survival: 73.9% versus 64.3%, p = 0.032) and within the ACLF patients (10-day survival: 97.8% versus 78.6%, p = 0.001; 30-day survival: 73.3% versus 58.5%, p = 0.041). Remarkably, HIT increased survival independently of ACLF grade. Independent predictors of survival were age, Model for End-Stage Liver Disease (MELD), ACLF grade, number of MARS sessions received, and intensity of MARS therapy. Conclusion: HIT with albumin dialysis may improve survival in patients with ACLF. Appropriate treatment schedules should be determined in future clinical trials.

Download Full-text

PGI12 THE COSTS OF ACUTE-ON-CHRONIC LIVER FAILURE—A BOTTOM-UP ANALYSIS BASED ON INDIVIDUAL PATIENT DATA

Value in Health ◽

10.1016/s1098-3015(10)67519-5 ◽

2005 ◽

Vol 8 (6) ◽

pp. A121-A122

Author(s):

FP Hessel ◽

S Mitzner ◽

J Wasem

Keyword(s):

Liver Failure ◽

Individual Patient Data ◽

Patient Data ◽

Chronic Liver ◽

Chronic Liver Failure ◽

Bottom Up

Download Full-text

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

Annals of Intensive Care ◽

10.1186/s13613-020-00795-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Klementina Ocskay ◽

Anna Kanjo ◽

Noémi Gede ◽

Zsolt Szakács ◽

Gabriella Pár ◽

...

Keyword(s):

Liver Failure ◽

Support Systems ◽

Meta Analysis ◽

Statistical Significance ◽

Bioartificial Liver ◽

Chronic Liver ◽

Chronic Liver Failure ◽

Liver Support ◽

Bioartificial Liver Support ◽

The Impact

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.

Download Full-text

Systematic review with meta-analysis: liver transplant provides survival benefit in patients with acute on chronic liver failure

Alimentary Pharmacology & Therapeutics ◽

10.1111/apt.15793 ◽

2020 ◽

Vol 52 (2) ◽

pp. 222-232 ◽

Cited By ~ 3

Author(s):

Mohamed A. Abdallah ◽

Muhammad Waleed ◽

Matthew G. Bell ◽

Morgan Nelson ◽

Robert Wong ◽

...

Keyword(s):

Systematic Review ◽

Liver Failure ◽

Liver Transplant ◽

Survival Benefit ◽

Meta Analysis ◽

Chronic Liver ◽

Chronic Liver Failure

Download Full-text

EXTRACORPOREAL LIVER SUPPORT IN PATIENTS WITH ACUTE OR ACUTE ON CHRONIC LIVER FAILURE: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED TRIALS

CHEST Journal ◽

10.1016/j.chest.2019.02.115 ◽

2019 ◽

Vol 155 (4) ◽

pp. 116A ◽

Cited By ~ 1

Author(s):

F. Alshamsi ◽

K. Alshammari ◽

E. Belly-Cote ◽

J. Dionne ◽

T. Albrahim ◽

...

Keyword(s):

Systematic Review ◽

Liver Failure ◽

Randomized Trials ◽

Meta Analysis ◽

Chronic Liver ◽

Chronic Liver Failure ◽

Liver Support ◽

Extracorporeal Liver Support

Download Full-text

Effectiveness of granulocyte colony-stimulating factor for patients with acute-on-chronic liver failure: a meta-analysis

Annals of Saudi Medicine ◽

10.5144/0256-4947.2021.383 ◽

2021 ◽

Vol 41 (6) ◽

pp. 383-391

Author(s):

Wei Huang ◽

Yuanji Ma ◽

Lingyao Du ◽

Shuang Kang ◽

Chang-Hai Liu ◽

...

Keyword(s):

Liver Failure ◽

Sample Size ◽

Meta Analysis ◽

Survival Rates ◽

Chronic Liver ◽

Cochrane Library ◽

Granulocyte Colony Stimulating Factor ◽

Colony Stimulating Factor ◽

Chronic Liver Failure ◽

Stimulating Factor

BACKGROUND: The safety and efficacy of granulocyte colony-stimulating factor (G-CSF) for the treatment of acute-on-chronic liver failure (ACLF) remain uncertain. Therefore, we conducted a meta-analysis to draw a firmer conclusion. METHODS: We searched the Cochrane library, PubMed, Embase, and China Biology Medicine disc to identify relevant RCTs performed before January 2020. Risk ratios (RRs) and their 95% confidence intervals (95% CIs) were calculated using a random effects model. MAIN OUTCOME MEASURES: RRs (95% CI) for 1-, 2-, and 3-month survival rates. SAMPLE SIZE: Six RCTs, including three open-label studies. RESULTS: The six studies included 246 subjects (121 in a G-CSF group and 125 in a control group). G-CSF administration significantly improved the 1-, 2-, and 3-month survival rates in patients with ACLF. The pooled RRs (95% CI, P) were 0.43 (0.27–0.69, P =.0004), 0.44 (0.32–0.62, P <.00001), and 0.39 (0.22–0.68, P =.0009), respectively. CONCLUSION: G-CSF may be beneficial and effective in the treatment of ACLF, but further studies are needed to verify this conclusion. LIMITATIONS: The sample size was small, and studies were restricted to countries in Asia. PROSPERO REGISTRATION NUMBER: CRD42021225681 CONFLICT OF INTEREST: None.

Download Full-text