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Meta-Analysis
. 2022 Aug 30;17(8):e0273231.
doi: 10.1371/journal.pone.0273231. eCollection 2022.

Antibiotics and probiotics on hepatic venous pressure gradient in cirrhosis: A systematic review and a meta-analysis

Haonan Zhang  1 , Jian Gao  2
Affiliations
Meta-Analysis

Antibiotics and probiotics on hepatic venous pressure gradient in cirrhosis: A systematic review and a meta-analysis

Haonan Zhang et al. PLoS One. .

Abstract

Background: Modulation of the gut microbiome could favorably alter the hepatic venous pressure gradient (HVPG) in cirrhosis and portal hypertension (PH).

Aim: This meta-analysis was to evaluate the effects of microbiome-targeted therapies (MTTs) on HVPG in persons with cirrhosis and PH.

Methods: PubMed, The Cochrane Library, Embase, Web of Science and Scopus were searched for randomized clinical trials (RCTs) analyzing the effects on HVPG in people with cirrhosis who received MTTs. Clinical outcomes were pooled using RevMan5.3 software. A trial sequential analysis was applied to calculate the required information size and evaluate the credibility of the meta-analysis results.

Results: A total of six studies were included. MTTs were associated with a reduction of 1.22 mm Hg in HVPG (95% CI: -2.31, -0.14 mmHg, P = 0.03). Subgroup analysis showed a greater reduction with longer duration (-1.88 mmHg;95% CI: -3.23, -0.53; P = 0.006). In the trial sequential analysis of HVPG reduction, the cumulative Z curve crossed the traditional significance boundary without the achievement of required information size (330).

Conclusions: MTTs may be associated with a reduction in HVPG in patients with cirrhosis and PH. Microbiome-targeted therapies merit additional large-sample studies to define the efficacy of HVPG.

Systematic review registration: PROSPERO 2020: CRD4202021609.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow chart of the screening process.
Fig 2
Fig 2. Quality assessment of RCTs for risk of bias.
Fig 3
Fig 3. Forest plot of MTT on HVPG reduction in cirrhosis patients.
Fig 4
Fig 4. Forest plot of antibiotics and probiotics on HVPG reduction in cirrhosis patients.
Fig 5
Fig 5. Forest plot according to duration of MTT on HVPG reduction in cirrhosis patients.
Fig 6
Fig 6. Forest plot of MTT on LBP, TNF-α, IL-6 and NO.
Fig 7
Fig 7. Trial sequential analysis.
See this image and copyright information in PMC

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