ABSTRACT
Se ha realizado una revisión sistemática con el objetivo de describir los instrumentos de soporte hepático artificial utilizados en pacientes con insuficiencia hepática y evaluar su eficacia y seguridad. De las 436 referencias identificadas, sólo 10 ensayos clínicos cumplían los criterios de inclusión y disponían de la información necesaria para incluirse en la revisión. Las intervenciones estudiadas fueron Molecular Adsorbent Recirculating System, sistema Prometheus y Biologic-DT. Estos sistemas disminuyen el valor de bilirrubina, creatinina y otros elementos tóxicos. Asimismo, la eficacia clínica se demuestra con una mejoría de la encefalopatía hepática y un aumento de la supervivencia. La seguridad de la intervención se valora en pocos estudios y las alteraciones en la coagulación son los acontecimientos adversos más notificados. Existe suficiente evidencia científica que respalda que estos sistemas son capaces de mejorar la clínica de los pacientes de una manera segura. Confirmar su impacto sobre la supervivencia de los pacientes es ahora una prioridad (AU)
We performed a systematic review to assess the efficacy and safety of extracorporeal albumin dialysissystems in patients with liver failure. After screening 436 references, 10 controlled trials were detected. The analyzed interventions were MARS, Prometheus and Biologic-DT. Efficacy was proven by a reductionin bilirubin, creatinine and other toxic components after ntervention. Clinical efficacy was measured in fewer studies, some of them showing an improvement in hepatic encephalopathy and survival. Intervention safety was assessed in a reduced number of studies and based on adverse events, being coagulation disorders in most cases. In summary, reviewed evidence showed that albumin dialysis based systems were able to reduce toxic parameters and improve clinical results in these settings. However,more studies are needed to further evaluate survival and adverse events based on standardisednotification (AU)
Subject(s)
Humans , Hepatic Insufficiency/therapy , Liver, Artificial , Disease-Free Survival , Blood Coagulation Disorders/epidemiology , Chemical and Drug Induced Liver Injury/therapyABSTRACT
We performed a systematic review to assess the efficacy and safety of extracorporeal albumin dialysis systems in patients with liver failure. After screening 436 references, 10 controlled trials were detected. The analyzed interventions were MARS, Prometheus and Biologic-DT. Efficacy was proven by a reduction in bilirubin, creatinine and other toxic components after intervention. Clinical efficacy was measured in fewer studies, some of them showing an improvement in hepatic encephalopathy and survival. Intervention safety was assessed in a reduced number of studies and based on adverse events, being coagulation disorders in most cases. In summary, reviewed evidence showed that albumin dialysis based systems were able to reduce toxic parameters and improve clinical results in these settings. However, more studies are needed to further evaluate survival and adverse events based on standardised notification.
