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

Xinxing Tantai

doi: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.

Highlights

Cirrhosis results from any chronic liver disease, which is the fifth leading cause of adult deaths and the eighth in economic cost among the major illnesses [1]
In the present meta-analysis, we found that use of statins was associated with a significant 56% reduction in the risk of progression to decompensated cirrhosis and 47% lower risk of mortality
It was noteworthy that adverse drug events from statins were comparable to nonusers, and statins using in cirrhosis did not significantly increase the incidence of adverse events

Summary

Introduction

Cirrhosis results from any chronic liver disease, which is the fifth leading cause of adult deaths and the eighth in economic cost among the major illnesses [1]. According to the differences in prognosis, cirrhosis may be generally categorized as either compensated or decompensated. This classification mainly depends on the presence or absence of clinically evident decompensating events including variceal hemorrhage, ascites, and encephalopathy. Portal hypertension, determined by the hepatic venous pressure gradient (HVPG), is the initial and primary consequence of cirrhosis and results in the majority of its complications [4]. For portal hypertension, using statins could increase the HVPG response rate, pooled RR was 2.61(1.03–6.62). Conclusions: Statin use may be associated with reduced risk of hepatic decompensation and mortality in cirrhosis with well tolerated. Statin use appears to decrease portal hypertension and reduce the risk of initial variceal bleeding, ascites and hepatocellular carcinoma.

Methods

Results

Discussion

Conclusion