American Journal of Internal Medicine

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Effects of Statins on the Hepatic Decompensation, Mortality, Complications and Drug Safety in Liver Cirrhosis: A Systematic Review and Meta-Analysis

Received: Jul. 13, 2018    Accepted: Jul. 26, 2018    Published: Aug. 31, 2018
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Abstract

Background and Aim: Evidence indicates statins seem to improve outcomes in cirrhotic patients. Systematic review and meta-analysis are performed to evaluate the effect and safety of statins in the setting of cirrhosis. Methods: We searched PubMed, EMBASE, and the Cochrane Library from inception through January 2018 to identify comparative studies evaluating the role of statins in cirrhosis. Pooled risk estimates with 95% confidence intervals were calculated using a random effects model. Results: Eight studies (4 retrospective cohort studies and 4 randomized controlled trials) involving 3,966 cirrhotic patients were included. Statin use was associated with 56% lower risk of progression to decompensated cirrhosis (RR, 0.44; 95% CI, 0.36–0.54) and 47% lower risk of mortality (RR, 0.53; 95% CI, 0.47–0.61). Subgroup analyses showed that these results were generally consistent regardless of study design, etiology of cirrhosis, stage of cirrhosis, follow-up time, method of identifying cirrhosis. For initial variceal bleeding, pooled RR was 0.48 (0.35–0.67). For ascites, pooled RR was 0.66 (0.45–0.99). For portal hypertension, using statins could increase the HVPG response rate, pooled RR was 2.61(1.03–6.62). For hepatocellular carcinoma, pooled RR was 0.47(0.36–0.63). For any adverse event and serious adverse events, using statins was almost equivalent to nonusers, pooled RR was 1.06 (0.50-2.25) and 0.77 (0.31–1.95). Conclusions: Statin use may be associated with reduced risk of hepatic decompensation and mortality in cirrhosis with well tolerated. Additionally, statin use appears to decrease portal hypertension and reduce the risk of initial variceal bleeding, ascites and hepatocellular carcinoma. Further RCTs will be required to confirm our findings.

DOI 10.11648/j.ajim.20180605.14
Published in American Journal of Internal Medicine ( Volume 6, Issue 5, September 2018 )
Page(s) 108-120
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Statin, Liver Cirrhosis, Decompensation, Mortality, Meta-analysis

References
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    Xinxing Tantai, Longbao Yang, Zhongcao Wei, Cailan Xiao, Lirong Chen, et al. (2018). Effects of Statins on the Hepatic Decompensation, Mortality, Complications and Drug Safety in Liver Cirrhosis: A Systematic Review and Meta-Analysis. American Journal of Internal Medicine, 6(5), 108-120. https://doi.org/10.11648/j.ajim.20180605.14

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    ACS Style

    Xinxing Tantai; Longbao Yang; Zhongcao Wei; Cailan Xiao; Lirong Chen, et al. Effects of Statins on the Hepatic Decompensation, Mortality, Complications and Drug Safety in Liver Cirrhosis: A Systematic Review and Meta-Analysis. Am. J. Intern. Med. 2018, 6(5), 108-120. doi: 10.11648/j.ajim.20180605.14

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    AMA Style

    Xinxing Tantai, Longbao Yang, Zhongcao Wei, Cailan Xiao, Lirong Chen, et al. Effects of Statins on the Hepatic Decompensation, Mortality, Complications and Drug Safety in Liver Cirrhosis: A Systematic Review and Meta-Analysis. Am J Intern Med. 2018;6(5):108-120. doi: 10.11648/j.ajim.20180605.14

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  • @article{10.11648/j.ajim.20180605.14,
      author = {Xinxing Tantai and Longbao Yang and Zhongcao Wei and Cailan Xiao and Lirong Chen and Jinhai Wang and Na Liu},
      title = {Effects of Statins on the Hepatic Decompensation, Mortality, Complications and Drug Safety in Liver Cirrhosis: A Systematic Review and Meta-Analysis},
      journal = {American Journal of Internal Medicine},
      volume = {6},
      number = {5},
      pages = {108-120},
      doi = {10.11648/j.ajim.20180605.14},
      url = {https://doi.org/10.11648/j.ajim.20180605.14},
      eprint = {https://download.sciencepg.com/pdf/10.11648.j.ajim.20180605.14},
      abstract = {Background and Aim: Evidence indicates statins seem to improve outcomes in cirrhotic patients. Systematic review and meta-analysis are performed to evaluate the effect and safety of statins in the setting of cirrhosis. Methods: We searched PubMed, EMBASE, and the Cochrane Library from inception through January 2018 to identify comparative studies evaluating the role of statins in cirrhosis. Pooled risk estimates with 95% confidence intervals were calculated using a random effects model. Results: Eight studies (4 retrospective cohort studies and 4 randomized controlled trials) involving 3,966 cirrhotic patients were included. Statin use was associated with 56% lower risk of progression to decompensated cirrhosis (RR, 0.44; 95% CI, 0.36–0.54) and 47% lower risk of mortality (RR, 0.53; 95% CI, 0.47–0.61). Subgroup analyses showed that these results were generally consistent regardless of study design, etiology of cirrhosis, stage of cirrhosis, follow-up time, method of identifying cirrhosis. For initial variceal bleeding, pooled RR was 0.48 (0.35–0.67). For ascites, pooled RR was 0.66 (0.45–0.99). For portal hypertension, using statins could increase the HVPG response rate, pooled RR was 2.61(1.03–6.62). For hepatocellular carcinoma, pooled RR was 0.47(0.36–0.63). For any adverse event and serious adverse events, using statins was almost equivalent to nonusers, pooled RR was 1.06 (0.50-2.25) and 0.77 (0.31–1.95). Conclusions: Statin use may be associated with reduced risk of hepatic decompensation and mortality in cirrhosis with well tolerated. Additionally, statin use appears to decrease portal hypertension and reduce the risk of initial variceal bleeding, ascites and hepatocellular carcinoma. Further RCTs will be required to confirm our findings.},
     year = {2018}
    }
    

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  • TY  - JOUR
    T1  - Effects of Statins on the Hepatic Decompensation, Mortality, Complications and Drug Safety in Liver Cirrhosis: A Systematic Review and Meta-Analysis
    AU  - Xinxing Tantai
    AU  - Longbao Yang
    AU  - Zhongcao Wei
    AU  - Cailan Xiao
    AU  - Lirong Chen
    AU  - Jinhai Wang
    AU  - Na Liu
    Y1  - 2018/08/31
    PY  - 2018
    N1  - https://doi.org/10.11648/j.ajim.20180605.14
    DO  - 10.11648/j.ajim.20180605.14
    T2  - American Journal of Internal Medicine
    JF  - American Journal of Internal Medicine
    JO  - American Journal of Internal Medicine
    SP  - 108
    EP  - 120
    PB  - Science Publishing Group
    SN  - 2330-4324
    UR  - https://doi.org/10.11648/j.ajim.20180605.14
    AB  - Background and Aim: Evidence indicates statins seem to improve outcomes in cirrhotic patients. Systematic review and meta-analysis are performed to evaluate the effect and safety of statins in the setting of cirrhosis. Methods: We searched PubMed, EMBASE, and the Cochrane Library from inception through January 2018 to identify comparative studies evaluating the role of statins in cirrhosis. Pooled risk estimates with 95% confidence intervals were calculated using a random effects model. Results: Eight studies (4 retrospective cohort studies and 4 randomized controlled trials) involving 3,966 cirrhotic patients were included. Statin use was associated with 56% lower risk of progression to decompensated cirrhosis (RR, 0.44; 95% CI, 0.36–0.54) and 47% lower risk of mortality (RR, 0.53; 95% CI, 0.47–0.61). Subgroup analyses showed that these results were generally consistent regardless of study design, etiology of cirrhosis, stage of cirrhosis, follow-up time, method of identifying cirrhosis. For initial variceal bleeding, pooled RR was 0.48 (0.35–0.67). For ascites, pooled RR was 0.66 (0.45–0.99). For portal hypertension, using statins could increase the HVPG response rate, pooled RR was 2.61(1.03–6.62). For hepatocellular carcinoma, pooled RR was 0.47(0.36–0.63). For any adverse event and serious adverse events, using statins was almost equivalent to nonusers, pooled RR was 1.06 (0.50-2.25) and 0.77 (0.31–1.95). Conclusions: Statin use may be associated with reduced risk of hepatic decompensation and mortality in cirrhosis with well tolerated. Additionally, statin use appears to decrease portal hypertension and reduce the risk of initial variceal bleeding, ascites and hepatocellular carcinoma. Further RCTs will be required to confirm our findings.
    VL  - 6
    IS  - 5
    ER  - 

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Author Information
  • Division of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China

  • Division of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China

  • Division of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China

  • Division of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China

  • Division of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China

  • Division of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China

  • Division of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China

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