Department of Critical Care Medicine, University of Alberta, 2-124 Clinical Sciences Building, 8440 112th St NW, Edmonton, AB, T6G 2B7, Canada.
Division of Gastroenterology, Department of Critical Care Medicine, University of Alberta, 1-40 Zeidler Ledcor Building, 8540-112 St, Edmonton, AB, T6G 2X8, Canada.
Syst Rev. 2020 Jun 16;9(1):143. doi: 10.1186/s13643-020-01405-7.
Acute liver failure is a rare syndrome with significant morbidity and mortality, particularly in absence of transplantation as a rescue therapy. An important mechanism contributing to mortality is hyperammonemia which drives cerebral edema and raised intracranial pressure. Multiple therapies for managing hyperammonemia have been trialed. Continuous renal replacement therapy is effective in treating hyperammonemia in other disease states (notably inborn errors of metabolism). Its efficacy in acute liver failure has been suggested but further investigation is required to prove this. The objective of this systematic review will be to determine the efficacy of continuous renal replacement therapy in patients with acute liver failure and its effect on mortality and transplant-free survival.
MEDLINE, EMBASE, Web of Science, and Cochrane Database will be searched. Identified studies will include all patients with acute liver failure in a critical care unit treated with continuous renal replacement therapy. Primary outcome will be effectiveness of ammonia clearance and mortality. Patients treated with any other modality of ammonia lowering therapy (such as plasma exchange or Molecular Adsorbent Recirculating System) will be excluded. Narrative synthesis of the identified studies will occur and if clinical homogeneity is identified, data will be pooled for meta-analysis using a DerSimonian-Laird random effects model.
We present a protocol for a systematic review seeking to establish a link between transplant-free survival in acute liver failure and the use of continuous renal replacement therapy. Given the anticipated paucity of literature on this subject, both narrative and quantitative syntheses are planned. SYSTEMATIC REVIEW REGISTRATION: (PROSPERO) CRD42019122520, registered April 16, 2019.
急性肝衰竭是一种罕见的综合征，发病率和死亡率都很高，尤其是在没有移植作为抢救治疗的情况下。导致死亡率升高的一个重要机制是血氨升高，血氨升高会导致脑水肿和颅内压升高。已经尝试了多种治疗高血氨的方法。连续肾脏替代疗法在治疗其他疾病状态（特别是遗传性代谢紊乱）中的高血氨方面是有效的。它在急性肝衰竭中的疗效已被提出，但需要进一步的研究来证明这一点。本系统综述的目的是确定连续肾脏替代疗法在急性肝衰竭患者中的疗效及其对死亡率和无移植生存率的影响。
将在 MEDLINE、EMBASE、Web of Science 和 Cochrane 数据库中进行检索。确定的研究将包括在重症监护病房接受连续肾脏替代治疗的所有急性肝衰竭患者。主要结局将是氨清除的效果和死亡率。将排除接受任何其他降低氨治疗方法（如血浆置换或分子吸附再循环系统）的患者。将对确定的研究进行叙述性综合分析，如果存在临床同质性，则使用 DerSimonian-Laird 随机效应模型对数据进行汇总分析。
我们提出了一项系统综述的方案，旨在确定急性肝衰竭患者无移植生存率与连续肾脏替代治疗之间的关系。鉴于关于这个主题的文献预计很少，我们计划进行叙述性和定量综合。系统评价注册：（PROSPERO）CRD42019122520，于 2019 年 4 月 16 日注册。
