Effectiveness Of Molecular Adsorbent Recycling System In Liver Failure:A Meta-analysis

ObjectiveThe artificial liver support system(ALSS)is effective in treatment of liver failure,and molecular adsorbent recycling system has been applied widely in clinical nowadays.To provide the evidence for the choice of clinical treatment,we conducted a meta-analysis to assess the effectiveness of molecular adsorbent recycling system in patients with liver failure.MethodsPubmed,Cochrane Library,Web of science,Embase,Ovid,CNKI,Wanfang,VIP database and China Biology Medicine were searched up to January 2018.Published randomized controlled trail studies and cohort studies with objective diagnosis of liver failure were included in any language.Interventions(treatment groups)included MARS,whereas the comparison interventions(control groups)adopted standard medical therapy.The primary outcomes were mortality and the level of total bilirubin,and the secondary outcomes were Hepatic Encephalopathy Grades and the level of mean arterial pressure,creatinine,ammonia,albumin and prothrombin time activity.Quality of included studies was evaluated using the Cochrane Collaboration’s tool for assessing risk of bias and Criteria for judging risk of bias in the ’Risk of bias’ assessment tool provided by Cochrane Handbook for systematic reviews of interventions version 5.1.0 for RCTs and Newcastle-Ottawa Scale for cohort studies.And the meta-analysis was performed using Revman 5.2 and Statas 12.0.ResultsFourteen studies,9 RCTs,and 5 cohort studies were enrolled,involving a total of 1080 patients.By meta-analysis,MARS significantly improved the mortality(RR=0.81,95%CI 0.69 to 0.94),P=0.008),hepatic encephalopathy grades(RR=1.64,95%CI1.15 to 2.32),P=0.006),the level of total bilirubin(MD=-4.41,95%CI-5.84 to-2.98,p<0.00001)and prothrombin time activity(MD=6.04,95%CI 3.63 to 8.45,P<0.00001)in patients diagnosesd with liver failure compared with SMT.There were no significant differences between two groups in the improvement of creatinine,ammonia,albumin and mean arterial pressure.ConclusionMolecular adsorbent recycling system resulted in a significant improvement in mortality,hepatic encephalopathy and the levels of total bilirubin and prothrombin time activity but had no beneficial effets on creatinine,ammonia,albumin and mean arterial pressure compared with standard medical therapy.Due to the limited quantity of the included studies,more studies would be needed to verify the conclusion above.