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Review
. 2023 Dec 27;12(1):67.
doi: 10.3390/biomedicines12010067.

Hemoadsorption Therapy for Critically Ill Patients with Acute Liver Dysfunction: A Meta-Analysis and Systematic Review

Caner Turan  1   2 , Csenge Erzsébet Szigetváry  1   2 , Tamás Kói  2   3 , Marie Anne Engh  2 , Işıl Atakan  2 , László Zubek  2 , Tamás Terebessy  2   4 , Péter Hegyi  2   5   6 , Zsolt Molnár  1   2   7
Affiliations
Review

Hemoadsorption Therapy for Critically Ill Patients with Acute Liver Dysfunction: A Meta-Analysis and Systematic Review

Caner Turan et al. Biomedicines. .

Abstract

Critically ill patients are at risk of developing acute liver dysfunction as part of multiorgan failure sequelae. Clearing the blood from toxic liver-related metabolites and cytokines could prevent further organ damage. Despite the increasing use of hemoadsorption for this purpose, evidence of its efficacy is lacking. Therefore, we conducted this systematic review and meta-analysis to assess the evidence on clinical outcomes following hemoadsorption therapy. A systematic search conducted in six electronic databases (PROSPERO registration: CRD42022286213) yielded 30 eligible publications between 2011 and 2023, reporting the use of hemoadsorption for a total of 335 patients presenting with liver dysfunction related to acute critical illness. Of those, 26 are case presentations (n = 84), 3 are observational studies (n = 142), and 1 is a registry analysis (n = 109). Analysis of data from individual cases showed a significant reduction in levels of aspartate transaminase (p = 0.03) and vasopressor need (p = 0.03) and a tendency to lower levels of total bilirubin, alanine transaminase, C-reactive protein, and creatinine. Pooled data showed a significant reduction in total bilirubin (mean difference of -4.79 mg/dL (95% CI: -6.25; -3.33), p = 0.002). The use of hemoadsorption for critically ill patients with acute liver dysfunction or failure seems to be safe and yields a trend towards improved liver function after therapy, but more high-quality evidence is crucially needed.

Keywords: critical care; database meta-analysis; hemoadsorption; liver dysfunction.

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Conflict of interest statement

Z.M. is a full-time employee of CytoSorbents Europe GmbH. The other authors state that they have no conflicts of interest.

Figures

Figure 1
Figure 1
PRISMA flowchart of included studies.
Figure 2
Figure 2
Total bilirubin levels. Forest plot of total bilirubin levels pre- and post-treatment with hemoadsorption [46,47,48,50].
Figure 3
Figure 3
Creatinine levels. Forest plot of serum creatinine levels pre- and post-treatment with hemoadsorption [47,48,50].
Figure 4
Figure 4
Box plots of individual case data: (A) alanine aminotransferase (ALT), (B) aspartate aminotransferase (AST), (C) bilirubin, (D) creatinine, (E) C-reactive protein (CRP), and (F) vasopressor need. Data were pooled from individual case reports and presented as box plots, representing pre- and post-treatment values. Changes in these parameters for each case are also depicted by lines connecting pre- and post-treatment values.
See this image and copyright information in PMC

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