Meta-Analysis of the efficacy of DPMAS-based artificial liver in the treatment of ACLF

Abstract Background & Aim: Many references have reported the feasibility of various artificial liver support systems in the treatment of acute-on-chronic liver failure caused by Hepatitis B. However, there is still controversy over their efficacy, safety, and impact on survival rates. Meta-analysis was conducted to assess the efficacy, safety, adverse reactions, and survival rate of hepatitis B-caused ACLF treated with artificial liver support systems based on the double plasma molecular absorption system (DPMAS). Methods: The keywords or abstractions “liver failure, severe hepatitis, acute-on-chronic liver failure” were searched on the databases such as CBM, PubMed, Cochrane library, etc. and the Revman5.3 software was used to analyze the literature data. Results: After analysis, DPMAS improved total bilirubin and 90-day survival rate higher than plasma exchange (PE). However, there was no statistical significance in international standardized ratio (INR). the results of international normalized ratio (INR) were [MD=0.06, 95% CI (-0.38, 0.49), P>0.05], that of 90-day survival rate were [OR=3.07, 95% CI (1.87, 5.02), P<0.05]. The improvement of total bilirubin (TBIL), albumin (ALB), alanine aminotransferase (ALT), the adverse reactions, the 90-day survival rate and the improvement rate after treatment all were better in DPMAS+PE than PE. However, there were no statistical significance in prothrombin activity (PTA), prothrombin time (PT),blood platelet (PLT), international standardized ratio (INR), hemoglobin (HB), and creatinine (Cr). Conclusion: Total bilirubin are reduced more in DPMAS than in PE after treatment, which might be related with the special bilirubin adsorption column (BS330II) in DPMAS. Whereas, the improvement in INR was not significant in DPMAS compared to PE, which may require additional investigation. The combination of DPMAS and PE reduced total bilirubin more effectively. Furthermore, while they were able to boost ALB, there was no difference in coagulation function, owing to the fact that PE could supply the proteins and coagulation components required by the human body. This meta-analysis also demonstrated that DPMAS+PE reduced the incidence of adverse reactions, increased the effective rate following treatment, and improved 90-day survival rate. Perhaps it's because DPMAS reduces the use of plasma products and removes more toxic substances like bilirubin and inflammatory agents