Critically ill patients are at risk of developing acute liver dysfunction as part
of multiorgan failure sequelae. Clearing the blood from toxic liver-related metabolites
and cytokines could prevent further organ damage. Despite the increasing use of hemoadsorption
for this purpose, evidence of its efficacy is lacking. Therefore, we conducted this
systematic review and meta-analysis to assess the evidence on clinical outcomes following
hemoadsorption therapy. A systematic search conducted in six electronic databases
(PROSPERO registration: CRD42022286213) yielded 30 eligible publications between 2011
and 2023, reporting the use of hemoadsorption for a total of 335 patients presenting
with liver dysfunction related to acute critical illness. Of those, 26 are case presentations
(n = 84), 3 are observational studies (n = 142), and 1 is a registry analysis (n =
109). Analysis of data from individual cases showed a significant reduction in levels
of aspartate transaminase (p = 0.03) and vasopressor need (p = 0.03) and a tendency
to lower levels of total bilirubin, alanine transaminase, C-reactive protein, and
creatinine. Pooled data showed a significant reduction in total bilirubin (mean difference
of −4.79 mg/dL (95% CI: −6.25; −3.33), p = 0.002). The use of hemoadsorption for critically
ill patients with acute liver dysfunction or failure seems to be safe and yields a
trend towards improved liver function after therapy, but more high-quality evidence
is crucially needed.
