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Comprehensive evaluation of effects and safety of statin on the progression of liver cirrhosis: a systematic review and meta-analysis

Dr Ziad Al Jarad, Gastroenterology specialist

MSc, PhD, MPH

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Background

Methods

Criteria

Bias

Outcomes

Conclusion

References

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Background

Methods

Criteria

Bias

Outcomes

Conclusion

References

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Liver cirrhosis

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Background

Methods

Criteria

Bias

Outcomes

Conclusion

References

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Background

Methods

Criteria

Bias

Outcomes

Conclusion

References

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01

02

04

03

C

O

P

I

Patients with liver cirrhosis

Intake of statin

No statin

Progression of liver cirrhosis and its complications

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Background

Methods

Criteria

Bias

Outcomes

Conclusion

References

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Background

Methods

Criteria

Bias

Outcomes

Conclusion

References

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Inclusion:

  • English language
  • Comparison between statin treatment and non-statin treatment group
  • Full text articles
  • Clear definition of decompensation events

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Exclusion:

  • Animal studies
  • Case reports
  • Case series
  • Reviews articles

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1776

633

17

1952

Cohort study (11)

RCT (6)

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Background

Methods

Criteria

Bias

Outcomes

Conclusion

References

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Background

Methods

Criteria

Bias

Outcomes

Conclusion

References

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Limitations:

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  • Some studies are observational

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  • No randomization

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  • Retrospective design

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  • Different kinds of statin

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Background

Methods

Criteria

Bias

Outcomes

Conclusion

References

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Background

Methods

Criteria

Bias

Outcomes

Conclusion

References

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Short term follow up (less than 3 months)

Hepatic venous pressure gradient (HVPG)

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decreased

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Long term follow up (up to 14 years)

1- Risk of mortality

22%

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2- Decompensation of liver cirrhosis

A- Hepatic encephalopathy

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B- Ascites

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C- Variceal haemorrhage

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D- Spontaneous bacterial peritonitis

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34%

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A- Hepatic encephalopathy

B- Ascites

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C- Esophageal variceal bleeding

D- Spontaneous bacterial peritonitis

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3- Hepatocellular carcinoma (HCC)

25%

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Dose-dependent effects of statin on HCC development, decompensated cirrhosis events and liver cirrhosis progression.

  • HCC

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High dose

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Medium dose

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Low dose

  • Decompensation events

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High dose

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Medium dose

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Low dose

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Progression of liver cirrhosis

High dose

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Medium dose

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Low dose

Fibrosis

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Incidence of adverse effects

  • Muscle injury

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  • Liver dysfunction

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  • Gastrointestinal problems (diarrhea)

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Worsening of ascites

Myalgia

No difference

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Background

Methods

Criteria

Bias

Outcomes

Conclusion

References

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Background

Methods

Criteria

Bias

Outcomes

Conclusion

References

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  • Portal vein hemodynamics

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  • Mortality

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  • Ascites

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  • Hepatic encephalopathy

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  • HCC

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​

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Benefit

No benefit

  • SBP

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  • Esophageal variceal bleeding

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V

S

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Take Home Message

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Background

Methods

Criteria

Bias

Outcomes

Conclusion

References

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Background

Methods

Criteria

Bias

Outcomes

Conclusion

References

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  • Comprehensive evaluation of effects and safety of statin on the progression of liver cirrhosis: a systematic review and meta-analysis�(December 2019)
  • Overview of medications adjustments for adult patients with cirrhosis (Up To Date)

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