Evidence map›Paper›PMID 33462764›Full record

ReviewAnnals of intensive care2021

Uncertainty in the impact of liver support systems in acute-on-chronic liver failure: a systematic review and network meta-analysis.

Klementina Ocskay, Anna Kanjo, Noémi Gede, Zsolt Szakács, Gabriella Pár, Bálint Erőss, Jan Stange, Steffen Mitzner, Péter Hegyi, Zsolt Molnár

Abstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in Annals of intensive care, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
32citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

32 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
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  9. Acute and non-acute decompensation of liver cirrhosis.Liver international : official journal of the International Association for the Study of the Liver · 2025
    Review
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  13. Observational
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Klementina OcskayInstitute for Translational Medicine, Medical School, University of Pécs, Szigeti út 12. 2nd floor, Pécs, 7624, Hungary.
Anna KanjoInstitute for Translational Medicine, Medical School, University of Pécs, Szigeti út 12. 2nd floor, Pécs, 7624, Hungary.
Noémi GedeInstitute for Translational Medicine, Medical School, University of Pécs, Szigeti út 12. 2nd floor, Pécs, 7624, Hungary.
Zsolt SzakácsInstitute for Translational Medicine, Medical School, University of Pécs, Szigeti út 12. 2nd floor, Pécs, 7624, Hungary.
Gabriella PárDivision of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary.
Bálint ErőssInstitute for Translational Medicine, Medical School, University of Pécs, Szigeti út 12. 2nd floor, Pécs, 7624, Hungary.
Jan StangeDivision of Nephrology, Department of Medicine, University of Rostock, Rostock, Germany.
Steffen MitznerDivision of Nephrology, Department of Medicine, University of Rostock, Rostock, Germany.
Péter HegyiInstitute for Translational Medicine, Medical School, University of Pécs, Szigeti út 12. 2nd floor, Pécs, 7624, Hungary.
Zsolt MolnárInstitute for Translational Medicine, Medical School, University of Pécs, Szigeti út 12. 2nd floor, Pécs, 7624, Hungary. zsoltmolna@gmail.com.ORCID http://orcid.org/0000-0002-1468-4058

Funding

European Regional Development Fund EFOP 3.6.2-16-2017-00006 - LIVE LONGEREuropean Regional Development Fund GINOP-2.3.2-15-2016-00048 - STAY ALIVE
6 · The paper itself

Abstract

backgroundThe role of artificial and bioartificial liver support systems in acute-on-chronic liver failure (ACLF) is still controversial. We aimed to perform the first network meta-analysis comparing and ranking different liver support systems and standard medical therapy (SMT) in patients with ACLF.

methodsThe study protocol was registered with PROSPERO (CRD42020155850). A systematic search was conducted in five databases. We conducted a Bayesian network meta-analysis of randomized controlled trials assessing the effect of artificial or bioartificial liver support systems on survival in patients with ACLF. Ranking was performed by calculating the surface under cumulative ranking (SUCRA) curve values. The RoB2 tool and a modified GRADE approach were used for the assessment of the risk of bias and quality of evidence (QE).

resultsIn the quantitative synthesis 16 trials were included, using MARS®, Prometheus®, ELAD®, plasma exchange (PE) and BioLogic-DT®. Overall (OS) and transplant-free (TFS) survival were assessed at 1 and 3 months. PE significantly improved 3-month OS compared to SMT (RR 0.74, CrI: 0.6-0.94) and ranked first on the cumulative ranking curves for both OS outcomes (SUCRA: 86% at 3 months; 77% at 1 month) and 3-month TFS (SUCRA: 87%) and second after ELAD for 1-month TFS (SUCRA: 76%). Other comparisons did not reach statistical significance. QE was moderate for PE concerning 1-month OS and both TFS outcomes. Other results were of very low certainty.

conclusionPE seems to be the best currently available liver support therapy in ACLF regarding 3-month OS. Based on the low QE, randomized trials are needed to confirm our findings for already existing options and to introduce new devices.

Indexed as

BioLogic-DTELADLiver support therapyMARSNetwork meta-analysisOverall survivalPlasma exchangePrometheusSUCRATransplant-free survival

Identifiers

PMID33462764
PMCPMC7813174

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.