Shen Yi, Wang Xu-Lin, Wang Bin, Shao Jian-Guo, Liu Yan-Mei, Qin Yan, Wang Lu-Jun, Qin Gang
From the Department of Epidemiology and Medical Statistics (YS, X-LW, Y-ML); Center for Liver Diseases, Nantong Third People's Hospital, Nantong University, China (BW, J-GS, L-JW, GQ); and Department of Internal Medicine, Singapore General Hospital, Singapore (YQ).
Medicine (Baltimore). 2016 Jan;95(3):e2506. doi: 10.1097/MD.0000000000002506.
The artificial liver support system (ALSS) offers the potential to improve the prognosis of patients with acute-on-chronic liver failure (ACLF). However, the literature has been inconsistent on its survival benefits. We aimed to conduct a time series-based meta-analysis of randomized clinical trials (RCTs) and observational studies which examined differences in mortality in ACLF patients treated with ALSS or not.MEDLINE, EMBASE, OVID, and COCHRANE library database were systemically searched up to December 2014. Quality of included studies was evaluated using the Jadad score. The outcome measure was mortality at different follow-up endpoints. Odds ratios (ORs) and survival curve data were pooled for analysis.Ten studies, 7 RCTs, and 3 controlled cohorts were enrolled, involving a total of 1682 ACLF patients, among whom 842 were treated with ALSS. ALSS was found to reduce the risk of short-term (1-month and 3-month) mortality for patients with ACLF by nearly 30%. Randomized trials and observational studies provided good internal and external validity respectively. The combined Kaplan-Meier curves showed a consistent pattern of findings. Meta-analysis also suggested that ALSS might reduce medium-term (6-month and 1-year) mortality risk by 30% and long-term (3-year) mortality risk by 50% in ACLF patients.ALSS therapy could reduce short-term mortality in patients with ACLF. Meanwhile, its impacts on medium- and long-term survival seem to be promising but remained inconclusive. Clinical utility of this system for survival benefit may be implied.
人工肝支持系统（ALSS）为改善慢性肝功能衰竭急性发作（ACLF）患者的预后提供了可能。然而，关于其生存获益的文献报道并不一致。我们旨在对随机临床试验（RCT）和观察性研究进行基于时间序列的荟萃分析，这些研究探讨了接受或未接受ALSS治疗的ACLF患者的死亡率差异。截至2014年12月，我们系统检索了MEDLINE、EMBASE、OVID和Cochrane图书馆数据库。使用Jadad评分评估纳入研究的质量。结局指标为不同随访终点的死亡率。汇总比值比（OR）和生存曲线数据进行分析。共纳入10项研究，其中7项RCT和3项对照队列研究，涉及1682例ACLF患者，其中842例接受了ALSS治疗。结果发现，ALSS可使ACLF患者短期（1个月和3个月）死亡风险降低近30%。随机试验和观察性研究分别具有良好的内部和外部效度。合并的Kaplan-Meier曲线显示出一致的结果模式。荟萃分析还表明，ALSS可能使ACLF患者中期（6个月和1年）死亡风险降低30%，长期（3年）死亡风险降低50%。ALSS治疗可降低ACLF患者的短期死亡率。同时，其对中期和长期生存的影响似乎很有前景，但仍无定论。该系统在生存获益方面的临床实用性可能值得探讨。
