Work

Effects of different therapeutic methods on the 90-day prognosis of patients with HBV-ACLF: A systematic review and network meta-analysis

Year: 2025

Type: review

Study designs: Systematic Review, Meta-Analysis

Abstract: BACKGROUND: The short-term mortality rate of hepatitis B virus related acute-on-chronic liver failure (HBV-ACLF) is relatively high, and the optimal therapeutic method for HBV-ACLF is still controversial. This study aimed to investigate the effects of different therapeutic methods on 90-day prognosis of HBV-ACLF patients. METHODS: PubMed, Embase, and Cochrane Library were searched from their inception date up to February 2, 2023. RCTs or cohort studies related to the treatment of HBV-ACLF with different therapies were identified. Therapeutic methods focused on plasma exchange (PE), mesenchymal stem cell (MSC), granulocyte colony-stimulating factor (G-CSF), glucocorticoid (GC), double plasma molecular absorption system (DPMAS), and nucleos(t)ide analogues. The primary outcome was the 90-day survival rate. The results for binary variables were calculated using odds ratio (OR), with a corresponding 95% confidence interval (CI). RESULTS: A total of 16 studies were included in this study, which contained the therapeutic methods of PE, GC, G-CSF, MSC, DPMAS + PE, MSC + PE. Compared to nucleos(t)ide analogues, treatment with MSC + PE, DPMAS + PE, G-CSF, MSC and PE increased the odds of 90-day survival rate (OR = 4.58, 95% CI: 1.95-10.75; OR = 2.95, 95% CI: 1.07-8.12; OR = 2.32, 95% CI: 1.15-4.69; OR = 2.36, 95% CI: 1.14-4.91; OR = 1.91, 95% CI: 1.42-2.77), respectively. The odds of the 90-day survival rate after being treated by MSC + PE were superior to PE (OR = 2.40, 95% CI: 1.05-5.51) and GC treatment (OR = 2.86, 95% CI: 1.01-8.09). MSC + PE exhibited the highest likelihood (0.92) of being the optimal therapeutic method in improving the prognosis of patients with HBV-ACLF. For single-drug regimens, G-CSF (0.58) ranks the highest. CONCLUSION: This meta-analysis showed that MSC + PE was the most effective therapy in improving the 90-day prognosis, and G-CSF was the potential optimal monotherapy in improving the 90-day prognosis of HBV-ACLF patients.

Source: Medicine

DOI: 10.1097/md.0000000000046388

Authors: Yin Hua, Huaqiang Liu, Yuqin He, Shousheng Liu, Yongning Xin

Institutions: Qingdao Municipal Hospital, Nanjing Medical University, University of Health and Rehabilitation Sciences

Language: English

Topic: Liver Disease and Transplantation

Subfield: Hepatology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $1,950