Liu Haiyu, Yang Zhibo, Luo Qiong, Lin Jianhui
Department of Pulmonary and Critical Care Medicine, Fujian Medical University Union Hospital, Fuzhou, China.
Department of Clinical Medicine, Clinical College of Anhui Medical University, Hefei, China.
Artif Organs. 2025 May;49(5):762-777. doi: 10.1111/aor.14915. Epub 2024 Nov 22.
The utilization of extracorporeal liver support systems is increasingly prevalent for the management of acute-on-chronic liver failure in clinical settings. Yet, the efficacy of these interventions in terms of tangible clinical benefits for patients remains a matter of debate, underscoring the need for meta-analysis.
An updated meta-analysis was performed to elucidate the relationship between the application of extracorporeal liver support versus standard pharmacological treatment and the prognostic endpoints of patient survival, specifically assessing 1-month and 3-month mortality rates, as well as the incidence of complications such as hepatic encephalopathy, spontaneous bacterial peritonitis, and hepatorenal syndrome. Literature were searched via PubMed, EMBASE, and Web of Science.
The meta-analysis revealed the following: the odds ratio for 1-month mortality was 0.63 (95% confidence interval [CIs]: 0.51-0.76), for 3-month mortality was 0.70 (95% CI: 0.61-0.81), for hepatic encephalopathy was 0.81 (95% CI: 0.67-0.97), for spontaneous bacterial peritonitis was 0.66 (95% CI: 0.44-0.99), and for hepatorenal syndrome was 0.68 (95% CI: 0.51-0.92). These results suggest that patients with acute-on-chronic liver failure undergoing extracorporeal liver support system therapy have significantly better survival rates and lower complication incidences compared to those receiving conventional drug therapy. Further subgroup analysis indicated that patients with lower model for end-stage liver disease (MELD) scores and reduced total bilirubin (Tbil) levels demonstrated greater benefits from extracorporeal hepatic support.
This study establishes that in the management of acute-on-chronic liver failure, extracorporeal liver support systems confer a survival advantage and reduce complications relative to standard pharmacotherapy.
在临床环境中，体外肝脏支持系统用于治疗慢加急性肝衰竭的情况日益普遍。然而，这些干预措施对患者实际临床益处的疗效仍存在争议，这突出了进行荟萃分析的必要性。
进行了一项更新的荟萃分析，以阐明体外肝脏支持与标准药物治疗的应用与患者生存的预后终点之间的关系，具体评估1个月和3个月的死亡率，以及肝性脑病、自发性细菌性腹膜炎和肝肾综合征等并发症的发生率。通过PubMed、EMBASE和科学网检索文献。
荟萃分析显示如下结果：1个月死亡率的优势比为0.63（95%置信区间[CI]：0.51 - 0.76），3个月死亡率的优势比为0.70（95%CI：0.61 - 0.81），肝性脑病的优势比为0.81（95%CI：0.67 - 0.97），自发性细菌性腹膜炎的优势比为0.66（95%CI：0.44 - 0.99），肝肾综合征的优势比为0.68（95%CI：0.51 - 0.92）。这些结果表明，与接受传统药物治疗的患者相比，接受体外肝脏支持系统治疗的慢加急性肝衰竭患者的生存率显著更高，并发症发生率更低。进一步的亚组分析表明，终末期肝病模型（MELD）评分较低且总胆红素（Tbil）水平降低的患者从体外肝脏支持中获益更大。
本研究证实，在慢加急性肝衰竭的治疗中，相对于标准药物治疗，体外肝脏支持系统具有生存优势并可减少并发症。
