Volume 30, Issue 2, 2021
DOI: 10.24205/03276716.2020.4064
Molecular Adsorbent Recirculating System for Acute Liver Failure and Acute-on-Chronic Liver Failure: A Meta-Analysis
Abstract
Objective: To systematically evaluate the efficacy and safety of Molecular adsorbent recirculating system (MARS) in the clinical treatment for acute liver failure (ALF) and acute-on-chronic liver failure (AOCLF).
Methods: Search EMABSE, PUBMED, and COCHRANE library database for the RCTs and Cohort Studies of MARS in the treatment of ALF and AOCLF up to June 2020. Two independent researchers screened and assessed the quality of the literature and extracted the data. Rev Man 5.2 software was applied for meta-analysis. Trial Sequential Analysis was used to evaluate the risk of random error and effectiveness of conclusion by using TSA software.
Results: A total of seven RCTs, two prospective cohort studies and 2 retrospective cohort studies were included. The analysis showed that MARS decreased total bilirubin [MD=-8.34, 95%CI=(-12.85, -3.82), P=0.0003], improved hepatic encephalopathy [RR=1.95, 95% CI=(1.43, 2.67), P<0.0001] and reduced mortality in the short-term (3 days to 30 days) group [RR=0.63, 95%CI=(0.47,0.84), P=0.002] rather than the long-term (90 days to 3 years) group [RR=0.85, 95% CI=(0.72, 1.00), P<0.04]. TSA of improvement of hepatic encephalopathy, mortality and total bilirubin passed the cumulative Z-Score, the conventional boundary value and the require information size, proving it reliable.
Conclusion: MARS in ALF and AOCLF was still indeterminate for the decrease of total bilirubin, the improvement of hepatic encephalopathy and the reduction of mortality. The MARS improved the short-term (3 days to 30 days) rather than the long-term (90 days to 3 years) survival rates. Future multicenter, large-scale, randomized controlled trials are necessary to further research of MARS therapy.
Keywords
MARS; ALF; ACLF; meta-analysis