{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T07:38:09Z","timestamp":1793173089193,"version":"4.5.0"},"reference-count":27,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T00:00:00Z","timestamp":1789344000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T00:00:00Z","timestamp":1789344000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Clinical Apheresis"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    NBALS efficacy in ACLF remains controversial. We aimed to determine if a \u201ctherapeutic window\u201d exists by stratifying clinical outcomes based on baseline Model for End\u2010Stage Liver Disease (MELD) scores. We searched PubMed, Embase, Cochrane Library, and Web of Science for RCTs and PSM\u2010cohorts comparing NBALS to standard medical therapy (SMT). Primary outcome was 28\u2010day mortality; MELD\u2010stratified subgroup analyses and random\u2010effects meta\u2010regression were performed. Eleven studies (comprising 12 datasets) involving 1958 patients (991 NBALS vs. 967 SMT) were included. Overall, NBALS significantly reduced 28\u2010day mortality compared with SMT (pooled RR 0.72, 95% CI [0.63\u20130.83],\n                    <jats:italic>I<\/jats:italic>\n                    <jats:sup>2<\/jats:sup>\n                    \u2009=\u20092.8%). Subgroup analysis suggested a clinical trend toward a distinct therapeutic window: the survival benefit was most significant in the Intermediate MELD group (25\u201330) (RR 0.65, 95% CI [0.52\u20130.81],\n                    <jats:italic>I<\/jats:italic>\n                    <jats:sup>2<\/jats:sup>\n                    \u2009=\u20090%) and the High MELD group (&gt;\u200930) (RR 0.75, 95% CI [0.58\u20130.98],\n                    <jats:italic>I<\/jats:italic>\n                    <jats:sup>2<\/jats:sup>\n                    \u2009=\u20090%), while substantial uncertainty exists regarding the survival benefit in the Low MELD group (&lt;\u200925) (RR 0.49, 95% CI [0.08\u20132.81],\n                    <jats:italic>I<\/jats:italic>\n                    <jats:sup>2<\/jats:sup>\n                    \u2009=\u200967.9%). Meta\u2010regression confirmed that the maximum survival benefit of NBALS is concentrated within a baseline MELD range of approximately 25 to 32. Furthermore, NBALS group achieved a significantly higher reduction in total bilirubin compared to SMT (pooled MD 98.15, 95% CI [66.50\u2013129.79],\n                    <jats:italic>I<\/jats:italic>\n                    <jats:sup>2<\/jats:sup>\n                    \u2009=\u200999.2%). NBALS significantly improves short\u2010term survival in ACLF, suggesting a potential therapeutic window around a baseline MELD range of 25\u201332. Early stratification based on disease severity is crucial for optimizing NBALS application.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Trial Registration:<\/jats:bold>\n                    PROSPERO CRD420261334987.\n                  <\/jats:p>","DOI":"10.1002\/jca.70177","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T03:10:56Z","timestamp":1789441856000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Optimal Therapeutic Window for Nonbioartificial Liver Support in Acute\u2010On\u2010Chronic Liver Failure: A Meta\u2010Analysis and Meta\u2010Regression Based on Baseline\n                    <scp>MELD<\/scp>\n                    Score"],"prefix":"10.1002","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-8636-9065","authenticated-orcid":false,"given":"Jiahao","family":"Li","sequence":"first","affiliation":[{"name":"Zhoukou Central Hospital Affiliated to Henan Medical University  Zhoukou Henan Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Liu","sequence":"additional","affiliation":[{"name":"Zhoukou Central Hospital Affiliated to Henan Medical University  Zhoukou Henan Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianying","family":"Shao","sequence":"additional","affiliation":[{"name":"Zhoukou Central Hospital Affiliated to Henan Medical University  Zhoukou Henan Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yali","family":"Cheng","sequence":"additional","affiliation":[{"name":"Zhoukou Central Hospital Affiliated to Henan Medical University  Zhoukou Henan Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiangkai","family":"Zeng","sequence":"additional","affiliation":[{"name":"Zhoukou Central Hospital Affiliated to Henan Medical University  Zhoukou Henan Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Han","family":"Li","sequence":"additional","affiliation":[{"name":"Zhoukou Central Hospital Affiliated to Henan Medical University  Zhoukou Henan Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haoqian","family":"Tan","sequence":"additional","affiliation":[{"name":"Zhoukou Central Hospital Affiliated to Henan Medical University  Zhoukou Henan Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junying","family":"Liu","sequence":"additional","affiliation":[{"name":"Zhoukou Central Hospital Affiliated to Henan Medical University  Zhoukou Henan Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,14]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2013.02.042"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12072-019-09946-3"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2010.03037.x"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-1594.1999.06122.x"},{"issue":"43","key":"e_1_2_11_6_1","first-page":"9591","article-title":"Therapeutic Plasma Exchange for Patients With HBV\u2010Associated Acute\u2010On\u2010Chronic Liver Failure","volume":"22","author":"Wan Y. M.","year":"2016","journal-title":"World Journal of Gastroenterology"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.26185"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2011.12.056"},{"issue":"5","key":"e_1_2_11_9_1","first-page":"612","article-title":"Effect of Plasma Exchange on Survival in Patients With HBV\u2010Related Acute\u2010On\u2010Chronic Liver Failure: A Propensity Score Matching Analysis","volume":"14","author":"Yang J.","year":"2020","journal-title":"Frontiers in Medicine"},{"issue":"18","key":"e_1_2_11_10_1","first-page":"2212","article-title":"Plasma Exchange\u2010Centered Artificial Liver Support System in Patients With Severe Hepatitis B\u2010Related Acute\u2010On\u2010Chronic Liver Failure","volume":"27","author":"Chen J. J.","year":"2021","journal-title":"World Journal of Gastroenterology"},{"issue":"12","key":"e_1_2_11_11_1","first-page":"3481","article-title":"Plasma Exchange Improves Survival in Patients With Acute\u2010On\u2010Chronic Liver Failure: A Propensity\u2010Score Matched Study","volume":"36","author":"Maiwall R.","year":"2021","journal-title":"Journal of Gastroenterology and Hepatology"},{"issue":"4","key":"e_1_2_11_12_1","first-page":"1070","article-title":"Nonbiologic Liver Support Devices: An Ongoing Search for the Holy Grail","volume":"53","author":"Putuvath P. J.","year":"2011","journal-title":"Hepatology"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1053\/jhep.2001.22172"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/ebmental-2019-300117"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v036.i03"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/hepr.13497"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.15858"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2023.03.013"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000000338"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.14806"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/jmv.28650"},{"issue":"4","key":"e_1_2_11_23_1","first-page":"908","article-title":"Double Plasma Molecular Adsorption System With Sequential Low\u2010Dose Plasma Exchange in Patients With Hepatitis B Virus\u2010Related Acute\u2010On\u2010Chronic Liver Failure: A Prospective Study","volume":"11","author":"Wang L.","year":"2023","journal-title":"Journal of Clinical and Translational Hepatology"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.21930"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2021.779744"},{"issue":"12","key":"e_1_2_11_26_1","first-page":"2153","article-title":"Acute\u2010On\u2010Chronic Liver Failure: A New Clinical Entity","volume":"13","author":"Arroyo V.","year":"2015","journal-title":"Clinical Gastroenterology and Hepatology"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2017-314641"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l4898"}],"container-title":["Journal of Clinical Apheresis"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jca.70177","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jca.70177","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jca.70177","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T07:14:55Z","timestamp":1793171695000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jca.70177"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,14]]},"references-count":27,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1002\/jca.70177"],"URL":"https:\/\/doi.org\/10.1002\/jca.70177","archive":["Portico"],"relation":{},"ISSN":["0733-2459","1098-1101"],"issn-type":[{"value":"0733-2459","type":"print"},{"value":"1098-1101","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,14]]},"assertion":[{"value":"2026-03-11","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-31","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-14","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70177"}}