Efficacy of molecular adsorbent recirculating system albumin dialysis in the treatment of hepatic encephalopathy associated with liver failure: a meta-analysis.

This meta-analysis aimed to systematically evaluate the efficacy (including improvement of biochemical indicators and clinical outcomes) and safety of the molecular adsorbent recirculating system (MARS) in the treatment of hepatic encephalopathy associated with liver failure. PubMed, EMBASE, Cochrane Library, Web of Science, CNKI, Wanfang, and VIP databases were systematically searched from inception to April 2024. Predefined inclusion criteria were used to assess study quality, and statistical analyses were performed using RevMan 5.4. Seven studies were included. Results showed that MARS significantly improved hemoglobin [standard mean difference (SMD): -0.81, 95% confidence interval (CI): -1.42 to -0.19, P  = 0.01], creatinine (SMD: -0.46, 95% CI: -0.68 to -0.24, P  < 0.0001), and international normalized ratio (INR) (SMD: -0.22, 95% CI: -0.43 to -0.01, P  = 0.004). However, effects on albumin (SMD: 0.60, 95% CI: -0.22 to 1.41, P  = 0.15) and bilirubin (SMD: -0.21, 95% CI: -0.78 to 0.35, P  = 0.46) were NS. No significant association was observed between MARS treatment and increased risk of bleeding (risk ratio: 1.23, 95% CI: 0.83 to 1.81, P  = 0.30) or infection (risk ratio: 1.23, 95% CI: 0.97 to 1.56, P  = 0.09). In conclusion, preliminary analysis suggests that MARS may help improve creatinine and INR levels in hepatic encephalopathy patients without significantly increasing bleeding or infection risks. However, because of the limited number and suboptimal quality of included studies and presence of heterogeneity, current evidence is insufficient. Rigorously designed, adequately powered, high-quality randomized controlled trials are needed to validate the precise efficacy and safety of MARS in hepatic encephalopathy treatment.