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

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 AC...

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Autores principales: Ocskay, Klementina, Kanjo, Anna, Gede, Noémi, Szakács, Zsolt, Pár, Gabriella, Erőss, Bálint, Stange, Jan, Mitzner, Steffen, Hegyi, Péter, Molnár, Zsolt
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7813174/
https://www.ncbi.nlm.nih.gov/pubmed/33462764
http://dx.doi.org/10.1186/s13613-020-00795-0
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author Ocskay, Klementina
Kanjo, Anna
Gede, Noémi
Szakács, Zsolt
Pár, Gabriella
Erőss, Bálint
Stange, Jan
Mitzner, Steffen
Hegyi, Péter
Molnár, Zsolt
author_facet Ocskay, Klementina
Kanjo, Anna
Gede, Noémi
Szakács, Zsolt
Pár, Gabriella
Erőss, Bálint
Stange, Jan
Mitzner, Steffen
Hegyi, Péter
Molnár, Zsolt
author_sort Ocskay, Klementina
collection PubMed
description 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.
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spelling pubmed-78131742021-01-18 Uncertainty in the impact of liver support systems in acute-on-chronic liver failure: a systematic review and network meta-analysis Ocskay, Klementina Kanjo, Anna Gede, Noémi Szakács, Zsolt Pár, Gabriella Erőss, Bálint Stange, Jan Mitzner, Steffen Hegyi, Péter Molnár, Zsolt Ann Intensive Care Review 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. Springer International Publishing 2021-01-18 /pmc/articles/PMC7813174/ /pubmed/33462764 http://dx.doi.org/10.1186/s13613-020-00795-0 Text en © The Author(s) 2021 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
spellingShingle Review
Ocskay, Klementina
Kanjo, Anna
Gede, Noémi
Szakács, Zsolt
Pár, Gabriella
Erőss, Bálint
Stange, Jan
Mitzner, Steffen
Hegyi, Péter
Molnár, Zsolt
Uncertainty in the impact of liver support systems in acute-on-chronic liver failure: a systematic review and network meta-analysis
title Uncertainty in the impact of liver support systems in acute-on-chronic liver failure: a systematic review and network meta-analysis
title_full Uncertainty in the impact of liver support systems in acute-on-chronic liver failure: a systematic review and network meta-analysis
title_fullStr Uncertainty in the impact of liver support systems in acute-on-chronic liver failure: a systematic review and network meta-analysis
title_full_unstemmed Uncertainty in the impact of liver support systems in acute-on-chronic liver failure: a systematic review and network meta-analysis
title_short Uncertainty in the impact of liver support systems in acute-on-chronic liver failure: a systematic review and network meta-analysis
title_sort uncertainty in the impact of liver support systems in acute-on-chronic liver failure: a systematic review and network meta-analysis
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7813174/
https://www.ncbi.nlm.nih.gov/pubmed/33462764
http://dx.doi.org/10.1186/s13613-020-00795-0
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