Hemoadsorption therapy for critically ill patients with acute liver dysfunction: A meta- analysis and systematic review

Abstract

Abstract Introduction Critically ill patients admitted to the ICU have been shown to be at risk of developing acute liver dysfunction usually as part of multiorgan failure sequelae. Clearing the blood from toxic liver-related metabolites and cytokines could prevent further organ damage. Despite the increasing use of hemoadsorption for this purpose, evidence of its efficacy is lacking. Objectives To appraise the evidence for the efficacy of hemoadsorption (HA) treatment for critical illness-associated acute liver dysfunction. Methods A systematic search was conducted on Pubmed, Embase, Scopus, CENTRAL, and Web of Science (PROSPERO registration: CRD42022286213). The target population was patients with acute liver dysfunction or failure associated with critical illness and treated with HA. Outcomes of interest were pre- and post-treatment changes in organ functions and mortality. Results The search yielded 30eligible publications between 2011 and 2023, which reported the use of HA for a total of 335patients who presented with liver dysfunction related to acute critical illness. Of those, 26are case presentations (n=84), three are observational studies (n=142) and one is a registry analysis (n=109). Analysis of data from individual cases showed a significant reduction in levels of AST (p = 0.03) and vasopressor need (p = 0.03), and a tendency to lower levels of total bilirubin, ALT,CRP, and creatinine. Pooled data showed a significant reduction in total bilirubin (mean difference of -4.79 mg/dL [95% CI: -6.25; -3.33], p=0.002). In the case of creatinine, the post-treatment mean values were smaller as well; however, the difference was not significant (mean difference: -0.38mg/dL [95% CI:-1.27; 0.5],p=0.203). Evidence is lacking on the effect of HA on mortality. No device-related adverse events were reported. Conclusions The use of HA for critically ill patients with acute liver dysfunction or failure seems to be safe and yields a trend towards improved liver function after therapy, but more high-quality evidence is crucially needed.