Publication: Meta-análisis de datos individuales de las variables predictoras del riesgo de muerte en pacientes con insuficiencia hepática crónica agudizada tratados mediante diálisis de albúmina
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2018-11-19
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Universidad Complutense de Madrid
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Abstract
La insuficiencia hepática crónica agudizada es una entidad de alta prevalencia y mortalidad en pacientes con cirrosis, cuya base fisiopatológica incluye una respuesta inflamatoria tóxica, que conduce finalmente a disfunción orgánica en distintos grados.Sin embargo, a pesar de la importancia de la enfermedad, existen escasas alternativas terapéuticas, más allá del tratamiento médico de soporte. El trasplante hepático es la alternativa más eficaz, pero la escasez de donantes dificulta el acceso.Los sistemas de soporte hepático artificial son una importante alternativa de tratamiento por su impacto potencial sobre los mecanismos fisiopatológicos de la enfermedad, y han demostrado distintos efectos beneficiosos, con resultados variables en cuanto a supervivencia.El sistema MARS se encuentra entre los más estudiados y utilizados de estos sistemas, habiéndose mostrado beneficios potenciales en supervivencia y en parámetros clínicos y hemodinámicos, con escasos efectos adversos. Sin embargo,los estudios existentes no permiten valorar correctamente la terapia.Además, la entidad ha sido recientemente redefinida por el proyecto CANONIC, con importantes implicaciones en el pronóstico, al permitir la clasificación de los pacientes en 4 estadios de gravedad en función, fundamentalmente, del grado y número de órganos que fracasan. El impacto del tratamiento con MARS en función de esta nueva gradación se desconoce hasta el momento...
Acute-on chronic liver failure (ACLF) is an entity with a high mortality and prevalence incirrhosis. The most important pathogenetic factor is the presence of a toxicinflammatory response that finally leads to organ failure in different grades. Despite theimportance of the disease there are no alternative therapies besides supportivetreatment. Liver transplantation is the most effective alternative in these patients, but itis highly limited by donor shortage.Artificial liver support systems are a theoretical therapeutic option due to its potentialimpact in the physiopathology. Furthermore, they have shown some beneficial effectsin intermediate variables with controversial results regarding survival.The molecular adsorbent recirculating system (MARS) is one of the most extensivelystudied and used artificial liver support systems showing benefits in clinical andhemodynamic parameters, with few adverse effects but without definitive findingsregarding survival. Nevertheless, this therapy cannot be correctly assessed with thecurrent studies.The concept of ACLF has been recently redefined by the CANONIC project. The mostimportant finding of this study is the classification of severity of patients in four stagesdepending on the grade and number of organ failure. Interestingly, the impact of thedifferent therapies has not been evaluated according this new classification...
Acute-on chronic liver failure (ACLF) is an entity with a high mortality and prevalence incirrhosis. The most important pathogenetic factor is the presence of a toxicinflammatory response that finally leads to organ failure in different grades. Despite theimportance of the disease there are no alternative therapies besides supportivetreatment. Liver transplantation is the most effective alternative in these patients, but itis highly limited by donor shortage.Artificial liver support systems are a theoretical therapeutic option due to its potentialimpact in the physiopathology. Furthermore, they have shown some beneficial effectsin intermediate variables with controversial results regarding survival.The molecular adsorbent recirculating system (MARS) is one of the most extensivelystudied and used artificial liver support systems showing benefits in clinical andhemodynamic parameters, with few adverse effects but without definitive findingsregarding survival. Nevertheless, this therapy cannot be correctly assessed with thecurrent studies.The concept of ACLF has been recently redefined by the CANONIC project. The mostimportant finding of this study is the classification of severity of patients in four stagesdepending on the grade and number of organ failure. Interestingly, the impact of thedifferent therapies has not been evaluated according this new classification...
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Tesis de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Medicina, leída el 26-06-2017