Meta-analysis of individual patient data of albumin dialysis in acute-on-chronic liver failure: focus on treatment intensity-Reference-Cited by-同舟云学术

Meta-analysis of individual patient data of albumin dialysis in acute-on-chronic liver failure: focus on treatment intensity

Published:2019-01 Issue: Volume:12 Page:175628481987956
ISSN:1756-2848
Container-title:Therapeutic Advances in Gastroenterology
language:en
Short-container-title:Therap Adv Gastroenterol

Author:

Bañares Rafael¹²³,Ibáñez-Samaniego Luis⁴³^ORCID,Torner Josep María⁵,Pavesi Marco⁵,Olmedo Carmen³,Catalina María Vega⁴³,Albillos Agustín⁶,Larsen Fin Stolze⁷,Nevens Frederik⁸,Hassanein Tarek⁹,Schmidt Harmuth¹⁰,Heeman Uwe¹¹,Jalan Rajiv¹²,Moreau Richard¹³,Arroyo Vicente⁵

Affiliation:

1. Servicio de Medicina del Aparato Digestivo, Hospital General Universitario Gregorio Marañón, C/ Dr. Esquerdo 46, 28007, Madrid, Spain

2. Facultad de Medicina, Universidad Complutense, Madrid, Spain

3. Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain

4. Servicio de Medicina de Aparato Digestivo, Hospital General Universitario Gregorio Marañón, CIBERehd, Madrid, Spain

5. EASL CLIF Consortium, European Foundation for the Study of Chronic Liver Failure (EfClif), Barcelona, Spain

6. Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, Spain

7. Department of Hepatology, Copenhagen University Rigshospitalet, Copenhagen, Denmark

8. Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Belgium

9. The University of California, San Diego School of Medicine, Southern California Liver Centers, Southern California Research Center, San Diego, USA

10. Klinik für Transplantationsmedizin, Universitätsklinikum Münster, Münster, Germany

11. Department of Nephrology, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany

12. Division of Medicine, UCL Medical School, Royal Free Hospital, UCL Institute for Liver and Digestive Health, London, UK

13. INSERM, Center de Recherche sur l’Inflammation (CRI); Université Paris Diderot, Sorbonne Paris; Service d’Hépatologie, Hôpital Beaujon, Clichy, France

Abstract

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.

Funder

Baxter

Publisher

SAGE Publications

Subject

Gastroenterology

Link

http://journals.sagepub.com/doi/pdf/10.1177/1756284819879565

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