PhD Scientific Days 2022

Clinical Medicine V. (Poster discussion will take place in the Aula during the Coffee Break)

Hemoadsorption therapy for critically ill patients with acute liver dysfunction

Text of the abstract

Introduction
Critically illness related acute liver dysfunction has been considered an inflammatory condition. Clearing the blood of liver related toxic metabolites and cytokines could prevent further organ damage. Despite increasing use of hemoadsorption (HA) for this purpose, evidence is lacking.
Aims
To perform a systematic review on use of HA for critical illness associated acute liver dysfunction to evaluate the level of evidence and generate hypotheses for future trials.
Methods
We performed a systematic literature search on Pubmed, Embase, Scopus, CENTRAL, and Web of Science (PROSPERO registration: CRD42022286213). Target population was patients with acute liver dysfunction associated with critical illness and treated with HA. Primary outcomes were the change in liver function parameters during HA and mortality. Data were analyzed using SPSS 26 software (IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp). Paired t-test was used for comparison, p<0.05 was considered statistically significant.
Results
Our search yielded 26 eligible publications between 2011 and 2022, which reported the use of hemoadsorption for a total 309 patients: 23 case presentations (number of patients, n=81), 2 retrospective studies (n=109) and 1 registry (n=109). Devices used: CytoSorb (19 datasets, n=218), Coupled Plasma Filtration Adsorption (4, n=88), oXiris (2, n=2), CytoSorb+oXiris (1, n=1). Pooling data from 5 studies (n=160) showed significant reduction in total bilirubin levels after HA: (mean difference) -4.52 [95% CI:-5.28 to -3.77] mg/dL. Data pooled from individual case reports (n=8) also revealed decreasing levels of total bilirubin: -3.82±5.87 mg/dL; ALT: -174±272.83 U/L; AST: -337.53±395.85 U/L and reduction of noradrenaline need (-0.33±0.45 mcg/kg/min) during treatment. Mortality was 38.5% in the observational studies, and the registry analysis reports 9.2% mortality at the end of HA therapy, with 56.9% hospital mortality. Treatment related adverse events were not reported.
Conclusion
Use of HA for critically ill patients with acute liver dysfunction seems to be safe and yield a trend towards improved liver function after HA, but quality of data is insufficient. Our results render the need of adequately designed clinical trials with the above-mentioned parameters as main outcomes.
Funding
There was no funding support for this study.