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- Title
Systematic review with meta‐analysis: automated low‐flow ascites pump therapy for refractory ascites.
- Authors
Lepida, Antonia; Marot, Astrid; Trépo, Eric; Degré, Delphine; Moreno, Christophe; Deltenre, Pierre
- Abstract
Summary: Background: Few effective treatments are available for patients with cirrhosis and refractory ascites. New treatment modalities are needed for these patients. Aim: To synthesise the available evidence on the efficacy and safety of automated low‐flow ascites pump therapy in patients with cirrhosis and refractory ascites. Methods: Electronic databases were searched for trials evaluating automated low‐flow ascites pump therapy in patients with refractory ascites. Results: Nine studies were included. Eight were case series, one was a randomised controlled trial. Pooled estimate rates were 0.62 (95% CI = 0.49‐0.74) for the absence of requirement of large volume paracentesis (LVP) after pump insertion, 0.30 (95% CI = 0.17‐0.47) for acute kidney injury, 0.27 (95% CI = 0.13‐0.49) for bacterial peritonitis and 0.20 (95% CI = 0.09‐0.37) for urinary tract infection. There was high heterogeneity between studies which was often reduced or eliminated in sensitivity analyses by excluding studies of patients with a mean or median model for end‐stage liver disease (MELD) score > 15. Results of sensitivity analyses were similar to those of overall analyses. Mean increase in serum creatinine level after pump insertion was 23 µmol/L (95% CI = 10‐35) with no heterogeneity between studies. The pooled estimate rate for pump‐related side effects was 0.77 (95% CI = 0.64‐0.87) with low heterogeneity between studies. Conclusion: This meta‐analysis demonstrates that most patients treated with automated low‐flow ascites pump therapy do not require LVP after pump insertion. Acute kidney injury occurs in 30% of patients and creatinine levels increase by a mean of 23 µmol/L after pump insertion. Bacterial peritonitis and urinary tract infection occur in 27% and 20% of patients respectively.
- Subjects
DRUG infusion pumps; URINARY tract infections; META-analysis; INSULIN pumps; ACUTE kidney failure; PUMPING machinery
- Publication
Alimentary Pharmacology & Therapeutics, 2019, Vol 50, Issue 9, p978
- ISSN
0269-2813
- Publication type
Article
- DOI
10.1111/apt.15502