Plasma exchange for acute and acute-on-chronic liver failure: A systematic review and meta-analysis

被引:9
|
作者
Beran, Azizullah [1 ]
Mohamed, Mouhand F. H. [2 ]
Shaear, Mohammad [3 ]
Nayfeh, Tarek [4 ]
Mhanna, Mohammed [5 ]
Srour, Omar [6 ]
Nawras, Mohamad [7 ]
Mentrose, Jonathan A. [8 ]
Assaly, Ragheb [9 ]
Kubal, Chandrashekhar A. [10 ]
Ghabril, Marwan S. [1 ]
Hernaez, Ruben [11 ,12 ,13 ]
Patidar, Kavish R. [11 ,12 ,14 ]
机构
[1] Indiana Univ, Div Gastroenterol & Hepatol, Indianapolis, IN USA
[2] Brown Univ, Warren Alpert Med Sch, Dept Internal Med, Providence, RI USA
[3] Cent Michigan Univ, Gen Surg Dept, Coll Med, Saginaw, MI USA
[4] Mayo Clin, Evidence Based Practice Res Program, Rochester, NY USA
[5] Univ Iowa, Dept Cardiol, Iowa City, IA USA
[6] Henry Ford Hlth Syst, Dept Crit Care & Pulm Med, Detroit, MI USA
[7] Univ Toledo, Coll Med & Life Sci, Toledo, OH USA
[8] Indiana Univ, Dept Internal Med, Indianapolis, IN USA
[9] Univ Toledo, Divison Crit Care & Pulm Med, Toledo, OH USA
[10] Indiana Univ, Div Transplantat, Dept Surg, Indianapolis, IN USA
[11] Baylor Coll Med, Dept Med, Sect Gastroenterol & Hepatol, Houston, TX USA
[12] Michael E DeBakey VA Med Ctr, Houston, TX USA
[13] Michael E DeBakey VA Med Ctr, Ctr Innovat Qual Effectiveness & Safety IQuESt, Houston, TX USA
[14] Michael E DeBakey VA Med Ctr, Baylor Sch Med, Sect Gastroenterol, 2002 Holcombe Blvd, Houston, TX 77030 USA
关键词
DISEASE SCORING SYSTEM; SHORT-TERM OUTCOMES; IMPROVES SHORT-TERM; SUPPORT-SYSTEM; PREDICTION VALUE; LONG-TERM; HEPATITIS; EXPERIENCE; PROGNOSIS; SURVIVAL;
D O I
10.1097/LVT.0000000000000231
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Plasma exchange (PE) is a promising therapeutic option in patients with acute liver failure (ALF) and acute-on-chronic liver failure (ACLF). However, the impact of PE on patient survival in these syndromes is unclear. We aimed to systematically investigate the use of PE in patients with ALF and ACLF compared with standard medical therapy (SMT). We searched PubMed/Embase/Cochrane databases to include all studies comparing PE versus SMT for patients >= 18 years of age with ALF and ACLF. Pooled risk ratios (RR) with corresponding 95% CIs were calculated by the Mantel-Haenszel method within a random-effect model. The primary outcome was 30-day survival for ACLF and ALF. Secondary outcomes were overall and 90-day survival for ALF and ACLF, respectively. Five studies, including 343 ALF patients (n = 174 PE vs. n = 169 SMT), and 20 studies, including 5,705 ACLF patients (n = 2,856 PE vs. n = 2,849 SMT), were analyzed. Compared with SMT, PE was significantly associated with higher 30-day (RR 1.41, 95% CI 1.06-1.87, p = 0.02) and overall (RR 1.35, 95% CI 1.12-1.63, p = 0.002) survival in ALF patients. In ACLF, PE was also significantly associated with higher 30-day (RR 1.36, 95% CI 1.22-1.52, p < 0.001) and 90-day (RR 1.21, 95% CI 1.10-1.34, p < 0.001) survival. On subgroup analysis of randomized controlled trials, results remained unchanged in ALF, but no differences in survival were found between PE and SMT in ACLF. In conclusion, PE is associated with improved survival in ALF and could improve survival in ACLF. PE may be considered in managing ALF and ACLF patients who are not liver transplant (LT) candidates or as a bridge to LT in otherwise eligible patients. Further randomized controlled trials are needed to confirm the survival benefit of PE in ACLF.
引用
收藏
页码:127 / 141
页数:15
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