Clinical effect of artificial liver support system in treatment of drug-induced liver failure: A Meta-analysis

Tian Bing; Li Fan; Deng BaoCheng

doi:10.3969/j.issn.1001-5256.2020.04.023

Volume 36 Issue 4

Apr. 2020

Turn off MathJax

Article Contents

Article Navigation > Journal of Clinical Hepatology > 2020 > 36(4): 823-828

PDF( 2585 KB)

Clinical effect of artificial liver support system in treatment of drug-induced liver failure: A Meta-analysis

DOI: 10.3969/j.issn.1001-5256.2020.04.023

Department of Infectious Diseases,The First Affiliated Hospital of China Medical University

Research funding:

Received Date: 2019-11-07
Published Date: 2020-04-20

Abstract

Abstract

Objective To systematically review the clinical of artificial liver support system( ALSS) in the treatment of drug-induced liver failure. Methods PubMed,Embase,The Cochrane Library,CMB,CNKI,and VIP databases were searched for related randomized controlled trials or randomized controlled trials on ALSS in the treatment of drug-induced liver failure published up to October 2019,and a statistical analysis was performed. Odds ratio( OR) was the effect size for categorical data,and the difference between groups was the effect size for continuous data. The weighted mean difference( WMD) method was used for the pooled analysis of effect size,and 95% confidence interval( CI) was calculated for each effect size. I2 and P values were used to evaluate the heterogeneity of the articles included in the analysis; a fixed effect model was used when I2< 50% and P > 0. 1,otherwise a random effects model was used. Results A total of 16 articles with 945 patients were included,with 520 patients in the ALSS + routine medical treatment( RMT) group and 425 in the RMT group. The meta-analysis showed that compared with the RMT group,the ALSS + RMT group had a significantly lower mortality rate of drug-induced liver failure( OR = 0. 27,95% CI: 0. 20-0. 36,P < 0. 001),significant improvements in albumin( Alb)( MD = 1. 21,95% CI: 0. 18-2. 25,P = 0. 02) and prothrombin activity( PTA)( MD = 11. 84,95% CI: 6. 34-17. 35,P < 0. 001),and a significant reduction in total bilirubin( TBil)( MD =-104. 97,95% CI:-163. 63 to-46. 30,P < 0. 001). Further analysis of Alb,TBil,and PTA after the withdrawal of ALSS showed that ALSS significantly improved Alb( MD = 1. 74,95% CI: 1. 20-2. 27,P < 0. 001) and PTA( MD = 4. 45,95% CI:2. 80-6. 10,P < 0. 001) and significantly reduced TBil( MD =-128. 41,95% CI:-217. 22 to-39. 59,P = 0. 005). Conclusion Compared with RMT alone,RMT combined with ALSS can significantly improve the main biochemical indicators of patients with drug-induced liver failure and reduce their mortality rate.
- liver failure,
- drug-induced liver injury,
- liver,artificial,
- Meta-analysis as topic

FullText(HTML)

References(33)

References

[1] REUBEN A,KOCH DG,LEE WM. Drug-induced acute liver failure:Results of a U. S. multicenter,prospective study[J].Hepatology,2010,52(6):2065-2076.

[2] WEI G,BERGQUIST A,BROOME U,et al. Acute liver failure in Sweden:Etiology and outcome[J]. J Intern Med,2007,262(3):393-401.

[3] WAI CT,TAN BH,CHAN CL,et al. Drug-induced liver injury at an Asian center:A prospective study[J]. Liver Int,2007,27(4):465-474.

[4] KIM JB,SOHN JH,LEE HL,et al. Clinical characteristics of acute toxic liver injury[J]. Korean J Hepatol,2004,10(2):125-134.

[5] ZHOU Y,YANG L,LIAO Z,et al. Epidemiology of drug-induced liver injury in China:A systematic analysis of the Chinese literature including 21,789 patients[J]. Eur J Gastroenterol Hepatol,2013,25(7):825-829.

[6] Drug-induced Liver Diseases Study Group,Chinese Society of Hepatology,Chinese Medical Association. Guidelines for the diagnosis and treatment of drug-induced liver injury[J].J Clin Hepatol,2015,31(11):1752-1769.(in Chinese)中华医学会肝病学分会药物性肝病学组．药物性肝损伤诊治指南[J]．临床肝胆病杂志，2015,31(11):1752-1769.

[7] Liver Failure and Artificial Liver Group,Chinese Society of Infectious Diseases,Chinese Medical Association; Severe Liver Disease and Artificial Liver Group,Chinese Society of Hepatology, Chinese Medical Association. Guideline for diagnosis and treatment of liver failure(2018)[J]. J Clin Hepatol,2019,35(1):38-44.(in Chinese)中华医学会感染病学分会肝衰竭与人工肝学组，中华医学会肝病学分会重型肝病与人工肝学组．肝衰竭诊治指南(2018年版)[J]．临床肝胆病杂志，2019,35(1):38-44.

[8] European Association for the Study of the Liver. EASL clinical practice guidelines:Drug-induced liver injury[J]. J Hepatol,2019,70(6):1222-1261.

[9] EGGER M,SCHNEIDER M,DAVEY SMITH G. Spurious precision? Meta-analysis of observational studies[J]. BMJ,1998,316(7125):140-144.

[10] CHEN LY,WANG WY,LU JJ,et al. Effect analysis of plasma exchange on patients with drug induced liver failure[J]. Drug Evaluation,2007,4(6):405-407.(in Chinese)陈立宇，王文雅，卢家桀，等．血浆置换对药物性肝衰竭治疗效果分析[J]．药品评价，2007,4(6):405-407.

[11] DAI W,YANG DG,LIU Y,et al. Effect of artificial liver support system treatment in patients with drug-induced hepatic failure[J]. J Clin Hepatol,2002,18(2):116-117.(in Chinese)戴炜，杨大国，刘粤，等．人工肝支持系统在药物性肝衰竭治疗中的应用[J]．临床肝胆病杂志，2002,18(2):116-117.

[12] NING J. Therapeutic effect of high-throughput CRRT combined with plasmapheresis on drug-induced liver failure[J].Chronic Pathematol J,2010,12(9):1015-1016.(in Chinese)宁军．高通量CRRT和血浆置换联合应用治疗药物性肝衰竭疗效分析[J]．慢性病学杂志，2010,12(9):1015-1016.

[13] SHANG J,XU Y,YANG YX,et al. Preliminary study on the effects of an artificial liver support system in the treatment of medicamentous liver insufficiency[J]. Chin J Hepatol,2005,13(11):836-838.(in Chinese)尚佳，徐芸，杨玉秀，等．人工肝支持系统治疗药物性肝损伤32例[J]．中华肝脏病杂志，2005,13(11):836-838.

[14] WANG H,LIU WS,ZHAI QH,et al. Evaluation of the effect of artificial liver plasmapheresis on the success rate of treatment for patients with drug-induced subacute liver failure[J]. Int J Nurs,2013,32(10):2394-2395.(in Chinese)王会，刘婉姝，翟庆慧，等．人工肝血浆置换术治疗对药物性亚急性肝衰竭患者救治成功率的影响评价[J]．国际护理学杂志，2013,32(10):2394-2395.

[15] WEI ZW. Plasma exchanges in treatment of patients with antitubercular agent-induced subacute hepatic failure[J]. J Prac Hepatol,2014,17(3):315-316.(in Chinese)韦贞伟．血浆置换治疗抗结核药物导致的亚急性肝衰竭患者23例[J]．实用肝脏病杂志，2014,17(3):315-316.

[16] WEI XM. Analysis of clinical effect of plasma exchange combined with hemoperfusion in treatment of drug-induced hepatic failure[J]. Chin J Misdiagn,2009,9(9):2050-2051.(in Chinese)魏小梅．血浆置换联合血液灌流治疗药物性肝衰竭临床疗效分析[J]．中国误诊学杂志，2009,9(9):2050-2051.

[17] ZHU HC,ZHAO WF,JIANG MH,et al. Traditional Chinese medicine-induced liver failure:An analysis of 45 cases[J].Chin J Gastroenterol Hepatol,2009,18(3):215-217.(in Chinese)朱海超，赵卫峰，江敏华，等．中药致肝衰竭45例临床分析[J]．胃肠病学和肝病学杂志，2009,18(3):215-217.

[18] ZHU QR,MEI XP. Effiacy analysis of plasma exchange therapy in 56 patients with drug-induced liver failure[J]. J Mod Med Health,2012,28(7):966-967.(in Chinese)朱其荣，梅小平．血浆置换治疗药物性肝衰竭56例疗效分析[J]．现代医药卫生，2012,28(7):966-967.

[19] LI M,WU JY. The therapeutic effect of artificial liver plasmapheresis on drug-induced liver failure[J]. J South Med Univ,2009,29(7):693-695.(in Chinese)黎明，吴锦瑜．人工肝血浆置换术治疗药物性肝衰竭疗效分析[J]．南方医科大学学报，2009,29(7):693-695.

[20] CHEN LG,GULENG B,REN JL,et al. Artificial liver support system in treatment of liver failure after acute poisoning[J].World J Emerg Med,2011,2(4):283-286.

[21] SALIBA F,CAMUS C,DURAND F,et al. Albumin dialysis with a noncell artificial liver support device in patients with acute liver failure:A randomized,controlled trial[J]. Ann Intern Med,2013,159(8):522-531.

[22] KARVELLAS CJ,BAGSHAW SM,MCDERMID RC,et al. A case-control study of single-pass albumin dialysis for acetaminophen-induced acute liver failure[J]. Blood Purif,2009,28(3):151-158.

[23] SCHMIDT LE,WANG LP,HANSEN BA,et al. Systemic hemodynamic effects of treatment with the molecular adsorbents recirculating system in patients with hyperacute liver failure:A prospective controlled trial[J]. Liver Transpl,2003,9(3):290-297.

[24] KANTOLA T,KOIVUSALO AM,HOCKERSTEDT K,et al. The effect of molecular adsorbent recirculating system treatment on survival,native liver recovery,and need for liver transplantation in acute liver failure patients[J]. Transpl Int,2008,21(9):857-866.

[25] BERGIS D,FRIEDRICH-RUST M,ZEUZEM S,et al. Treatment of amanita phalloides intoxication by fractionated plasma separation and adsorption(Prometheus)[J]. J Gastrointestin Liver Dis,2012,21(2):171-176.

[26] ELINAV E,PINSKER G,SAFADI R,et al. Association between consumption of herbalife nutritional supplements and acute hepatotoxicity[J]. J Hepatol,2007,47(4):514-520.

[27] SONG FJ,ZHU B,LYU S,et al. Clinical analysis of drug-induced liver failure:A report of 314 cases[J]. J Prac Hepatol,2019,22(2):216-219.(in Chinese)宋芳娇，朱冰，吕飒，等．314例药物性肝衰竭患者临床特征分析[J]．实用肝脏病杂志，2019,22(2):216-219.

[28] BANARES R,NEVENS F,LARSEN F S,et al. Extracorporeal albumin dialysis with the molecular adsorbent recirculating system in acute-on-chronic liver failure:The RELIEF trial[J].Hepatology,2013,57(3):1153-1162.

[29] de SILVESTRO G,MARSON P,BRANDOLESE R,et al. A single institution’s experience(1982-1999)with plasma-exchange therapy in patients with fulminant hepatic failure[J].Int J Artif Organs,2000,23(7):454-461.

[30] KONDRUP J,ALMDAL T,VILSTRUP H,et al. High volume plasma exchange in fulminant hepatic failure[J]. Int J Artif Organs,1992,15(11):669-676.

[31] LIU CT,CHEN TH,CHENG CY. Successful treatment of druginduced acute liver failure with high-volume plasma exchange[J]. J Clin Apher,2013,28(6):430-434.

[32] ADAMS DH,JU C,RAMAIAH SK,et al. Mechanisms of immune-mediated liver injury[J]. Toxicol Sci,2010,115(2):307-321.

[33] MAO WL,LOU YF,YE B,et al. Changes in peripheral CD4+CD25(high)regulatory T cells in the acute-on-chronic liver failure patients with plasma exchange treatment[J]. Inflammation,2012,35(2):436-444.

Relative Articles

Supplements(0)

Cited By

Proportional views

Proportional views

通讯作者: 陈斌, bchen63@163.com

1.
沈阳化工大学材料科学与工程学院沈阳 110142

Get Citation

PDF

XML

Article Metrics

Article views (1242) PDF downloads(214)

Clinical effect of artificial liver support system in treatment of drug-induced liver failure: A Meta-analysis

DOI: 10.3969/j.issn.1001-5256.2020.04.023

Abstract

References

Proportional views

Catalog

通讯作者: 陈斌, bchen63@163.com

Article Metrics

Proportional views

Related

Clinical effect of artificial liver support system in treatment of drug-induced liver failure: A Meta-analysis

DOI: 10.3969/j.issn.1001-5256.2020.04.023

Abstract

References

Proportional views

Catalog

通讯作者: 陈斌, bchen63@163.com

Article Metrics

Proportional views

Related

About Journal

Submission Guideline

Journal Online

Hepatobiliary College

Guidelines

Export File

Citation

Format

Content