Therapeutic efficacy of artificial liver support system for liver failure：a meta-analysis / 中华临床感染病杂志

ABSTRACT

Objective To evaluate the efficacy of artificial liver support system ( ALSS) combined with conventional medical treatment for liver failure .Methods Literature retrieval of Wanfang Data , CQVIP, CNKI, Medline, Cochrane Library and PubMed from 2004 to 2014 was conducted to identify all studies on ALSS in treatment of liver failure .The quality of the literature was assessed according to Cochrane systematic guide manual , and meta-analysis was performed using RevMan 5.3.Random-effects or fixed-effects model was performed based on the heterogeneity , and publication bias was evaluated with Begg ’ s funnel pot .Results A total of 20 randomized controlled clinical trials involving 2 356 patients were included for systematic review , among which 1 247 patients were treated with ALSS combined with medical therapy, and 1 109 patients were treated with medical therapy only .Meta-analysis showed that the mortality of patients with liver failure treated with combined therapy was 25.3%(316/1247), which was lower than that with medical treatment alone (524/1 109, 47.2%) ( OR=0.36, 95%CI0.30-0.43, Z=11.19, P<0.01).The mortality of patients with acute (subacute) and subacute-on-chronic liver failure treated with combined therapy (54/203, 26.6%) was lower than that with medical treatment group (76/188, 40.4%) (OR=0.53, 95%CI0.34-0.81, Z=2.91, P<0.01).The mortality of patients with chronic liver failure treated with combined therapy was 25.6% (89/347), which was also lower than that with medical treatment group (171/340, 50.3%) (OR=0.32, 95%CI0.23-0.45, Z=6.73, P<0.01). Mortality in patients received medical treatment plus molecular adsorption recirculation system , plasma exchange or multiple ALSS were 23.6% (26/110), 21.9% (126/575) and 29.7% (80/269), which were significantly lower than those in patients received only medical treatment [38.9%(42/108), 52.2%(257/492) and 45.4%(103/227)] (OR=0.48, 0.24 and 0.45, 95%CI0.26-0.88, 0.18-0.31 and 0.31-0.67, Z=2.38, 10.14 and 4.02, all P<0.05 or <0.01).Conclusion ALSS combined with medical therapy can reduce the mortality of patients with various types of liver failures .