Safety and efficacy of plasmapheresis in treatment of acute fatty liver of pregnancy—a systematic review and meta-analysis
IntroductionAcute fatty liver of pregnancy (AFLP) is a fatal disease occurring in 3rd trimester. The safety and efficacy of plasmapheresis/plasma exchange (PP/PE) as an adjunctive treatment in patients of AFLP has been studied. We performed systematic review and meta-analysis to estimate the clinica...
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Frontiers Media S.A.
2024-10-01
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2024.1433324/full |
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| author | Sujata Siwatch Arka De Bandhanjot Kaur Divjot Singh Lamba Simarpreet Kaur Virendra Singh Aravind Gandhi Periyasamy |
| author_facet | Sujata Siwatch Arka De Bandhanjot Kaur Divjot Singh Lamba Simarpreet Kaur Virendra Singh Aravind Gandhi Periyasamy |
| author_sort | Sujata Siwatch |
| collection | DOAJ |
| description | IntroductionAcute fatty liver of pregnancy (AFLP) is a fatal disease occurring in 3rd trimester. The safety and efficacy of plasmapheresis/plasma exchange (PP/PE) as an adjunctive treatment in patients of AFLP has been studied. We performed systematic review and meta-analysis to estimate the clinical parameters that included mortality rates and improvement of the biochemical parameters including Liver and Renal function enzymes, coagulopathy factors of AFLP patients.MethodsWe searched PubMed, Ovid MEDLINE, Cochrane, CINAHL and Scopus, ClinicalTrials.gov. RevMan statistical software was used for meta-analysis.ResultsPooled survival proportion for AFLP patients treated with PP/PE was 87.74% (95% CI: 82.84 to 91.65). Efficacy of PP/PE was studied by its effect on mortality. PE/PP was associated with the reduction in the mortality with pooled odds ratio of 0.51 (95% CI: 0.08 to 3.09) with I2 = 86%. Sensitivity analysis after excluding outlier study, yielded a pooled odds ratio of 0.19 (95% CI: 0.02 to 1.52) with reduced heterogeneity (I2 = 63%). Biochemical parameter analysis demonstrated significant improvement post-PP/PE treatment, including decreased bilirubin (MD: 8.30, 95% CI: 6.75 to 9.84), AST (MD: 107.25, 95% CI: 52.45 to 162.06), ALT (MD: 111.08, 95% CI: 27.18 to 194.97), creatinine (MD: 1.66, 95% CI: 1.39 to 1.93), and Prothrombin time (MD: 5.08, 95% CI: 2.93 to 7.22).DiscussionDespite some heterogeneity, PP/PE shows promise in improving biochemical parameters in AFLP patients. PE can serve as a therapeutic approach for AFLP particularly in severe or refractory cases. PE provides the time for organ to recover and helps in creating a homeostatic environment for liver. Large RCTs and propensity matched studies are needed to better understand the safety and efficacy of the treatment.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022315698. |
| format | Article |
| id | doaj-art-11927f30ccc84abb8412231e424fc13b |
| institution | OA Journals |
| issn | 2296-858X |
| language | English |
| publishDate | 2024-10-01 |
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| series | Frontiers in Medicine |
| spelling | doaj-art-11927f30ccc84abb8412231e424fc13b2025-08-20T01:47:50ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2024-10-011110.3389/fmed.2024.14333241433324Safety and efficacy of plasmapheresis in treatment of acute fatty liver of pregnancy—a systematic review and meta-analysisSujata Siwatch0Arka De1Bandhanjot Kaur2Divjot Singh Lamba3Simarpreet Kaur4Virendra Singh5Aravind Gandhi Periyasamy6Department of Obstetrics and Gynecology, PGIMER, Chandigarh, IndiaDepartment of Hepatology, PGIMER, Chandigarh, IndiaDepartment of Obstetrics and Gynecology, PGIMER, Chandigarh, IndiaDepartment of Transfusion Medicine, PGIMER, Chandigarh, IndiaDepartment of Medicine, Microbiology and Infectious Diseases, University of Calgary, Calgary, AB, CanadaDepartment of Hepatology, PGIMER, Chandigarh, IndiaDepartment of Community Medicine, All India Institute of Medical Sciences, Nagpur, IndiaIntroductionAcute fatty liver of pregnancy (AFLP) is a fatal disease occurring in 3rd trimester. The safety and efficacy of plasmapheresis/plasma exchange (PP/PE) as an adjunctive treatment in patients of AFLP has been studied. We performed systematic review and meta-analysis to estimate the clinical parameters that included mortality rates and improvement of the biochemical parameters including Liver and Renal function enzymes, coagulopathy factors of AFLP patients.MethodsWe searched PubMed, Ovid MEDLINE, Cochrane, CINAHL and Scopus, ClinicalTrials.gov. RevMan statistical software was used for meta-analysis.ResultsPooled survival proportion for AFLP patients treated with PP/PE was 87.74% (95% CI: 82.84 to 91.65). Efficacy of PP/PE was studied by its effect on mortality. PE/PP was associated with the reduction in the mortality with pooled odds ratio of 0.51 (95% CI: 0.08 to 3.09) with I2 = 86%. Sensitivity analysis after excluding outlier study, yielded a pooled odds ratio of 0.19 (95% CI: 0.02 to 1.52) with reduced heterogeneity (I2 = 63%). Biochemical parameter analysis demonstrated significant improvement post-PP/PE treatment, including decreased bilirubin (MD: 8.30, 95% CI: 6.75 to 9.84), AST (MD: 107.25, 95% CI: 52.45 to 162.06), ALT (MD: 111.08, 95% CI: 27.18 to 194.97), creatinine (MD: 1.66, 95% CI: 1.39 to 1.93), and Prothrombin time (MD: 5.08, 95% CI: 2.93 to 7.22).DiscussionDespite some heterogeneity, PP/PE shows promise in improving biochemical parameters in AFLP patients. PE can serve as a therapeutic approach for AFLP particularly in severe or refractory cases. PE provides the time for organ to recover and helps in creating a homeostatic environment for liver. Large RCTs and propensity matched studies are needed to better understand the safety and efficacy of the treatment.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022315698.https://www.frontiersin.org/articles/10.3389/fmed.2024.1433324/fullacute fatty liver of pregnancyplasmapheresisplasma exchangesafetyefficacymortality |
| spellingShingle | Sujata Siwatch Arka De Bandhanjot Kaur Divjot Singh Lamba Simarpreet Kaur Virendra Singh Aravind Gandhi Periyasamy Safety and efficacy of plasmapheresis in treatment of acute fatty liver of pregnancy—a systematic review and meta-analysis Frontiers in Medicine acute fatty liver of pregnancy plasmapheresis plasma exchange safety efficacy mortality |
| title | Safety and efficacy of plasmapheresis in treatment of acute fatty liver of pregnancy—a systematic review and meta-analysis |
| title_full | Safety and efficacy of plasmapheresis in treatment of acute fatty liver of pregnancy—a systematic review and meta-analysis |
| title_fullStr | Safety and efficacy of plasmapheresis in treatment of acute fatty liver of pregnancy—a systematic review and meta-analysis |
| title_full_unstemmed | Safety and efficacy of plasmapheresis in treatment of acute fatty liver of pregnancy—a systematic review and meta-analysis |
| title_short | Safety and efficacy of plasmapheresis in treatment of acute fatty liver of pregnancy—a systematic review and meta-analysis |
| title_sort | safety and efficacy of plasmapheresis in treatment of acute fatty liver of pregnancy a systematic review and meta analysis |
| topic | acute fatty liver of pregnancy plasmapheresis plasma exchange safety efficacy mortality |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2024.1433324/full |
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