Chunping Su

Transjugular Intrahepatic Portosystemic Shunt for Acute Variceal Bleeding: A Meta-analysis.

Background and Aims: Acute variceal bleeding is the most common lethal complication of liver cirrhosis. A meta-analysis was conducted to compare the outcomes of transjugular intrahepatic portosystemic shunt (TIPS) to those of medical/endoscopic therapy for acute variceal bleeding in cirrhotic patients. Methods: The PubMed, EMBASE, and Cochrane Library databases were searched for all relevant comparative studies. Odds ratios (OR) and hazard ratios (HR) with 95% confidence intervals (CI)were pooled for dichotomous and time-dependent variables, respectively. Subgroup analyses were performed according to the type of study design (randomized or nonrandomized studies), source of bleeding (esophageal or gastric varices), type of stent (covered or bare stent), and patient selection (high risk or unselected patients). Results: Six papers were eligible. TIPS was superior to medical/endoscopic therapy in decreasing the incidence of treatment failure (OR=0.22; 95% CI, 0.11-0.44), improving overall survival (HR=0.55; 95% CI, 0.38-0.812), and decreasing the incidence of bleeding-related death (OR=0.19; 95% CI, 0.06-0.59). Although TIPS did not significantly decrease the incidence of rebleeding (OR=0.27; 95% CI, 0.06-1.29), it became significantly greater in the subgroup meta-analyses of randomized studies (OR=0.09; 95% CI, 0.03-0.32) than in those of nonrandomized studies (OR=0.76; 95% CI, 0.40-1.45; subgroup difference, P=0.003), and in the subgroup meta-analyses of studies including high-risk patients (OR=0.06; 95% CI, 0.01-0.23) than in those including low-risk patients (OR=0.83; 95% CI, 0.44-1.56; subgroup difference, P=0.0007). In addition, TIPS did not significantly increase the incidence of posttreatment hepatic encephalopathy (OR=1.37; 95% CI, 0.63-2.99). Conclusions: With the exception of the benefit of prevention from treatment failure, TIPS with covered stents might improve the overall survival of high-risk patients with acute variceal bleeding.

Neutrophil-to-lymphocyte ratio for the prognostic assessment of hepatocellular carcinoma: A systematic review and meta-analysis of observational studies

Background and aims Neutrophil to lymphocyte ratio (NLR) is an inflammatory-based marker. A systematic review and meta-analysis was performed to explore the prognostic role of NLR in patients with hepatocellular carcinoma (HCC). Results Overall, 598 papers were identified, of which 90 papers including 20,475 HCC patients were finally included. Low baseline NLR was significantly associated with better overall survival (HR = 1.80, 95% CI: 1.59–2.04, p < 0.00001) and recurrence-free or disease-free survival (HR = 2.23, 95% CI: 1.80–2.76, p < 0.00001). Low post- treatment NLR was significantly associated with better overall survival (HR = 1.90, 95% CI: 1.22–2.94, p = 0.004). Decreased NLR was significantly associated with overall survival (HR = 2.23, 95%CI: 1.83–2.72, p < 0.00001) and recurrence-free or disease-free survival (HR = 2.23, 95% CI: 1.83–2.72, p < 0.00001). The findings from most of subgroup meta-analyses were consistent with those from the overall meta-analyses. Materials and Methods All relevant literatures were identified via PubMed, EMBASE, and Cochrane library databases. Hazard ratio (HR) with 95% confidence interval (95%CI) was calculated. Subgroup meta-analyses were performed according to the treatment options, NLR cut-off value ranges, and regions. Conclusions NLR should be a major prognostic factor for HCC patients. NLR might be further incorporated into the prognostic model of HCC.

Hepatic resection alone versus in combination with pre- and post-operative transarterial chemoembolization for the treatment of hepatocellular carcinoma: A systematic review and meta-analysis

Background and Aims The prognosis of hepatocellular carcinoma (HCC) treated with hepatic resection may be improved by the adjunctive use of transarterial chemoembolization (TACE). This study aimed to systematically compare the outcomes between hepatic resection with and without TACE groups. Methods All relevant randomized controlled trials (RCTs) and non-RCTs were searched by the PubMed, EMBASE, and Cochrane Library databases. Overall survival (OS) and disease-free survival (DFS) were two major outcomes. Meta-analyses were performed according to the timing of TACE (pre- or post-operative TACE). Subgroup analyses were also performed. Hazard ratios (HRs) with 95% confidence intervals (95%CIs) were calculated. Results Overall, 55 papers were included (14 RCTs and 41 non-RCTs). Overall meta-analyses demonstrated that OS and DFS were statistically similar between hepatic resection with and without pre-operative TACE groups (HR = 1.01, 95%CI = 0.87–1.19, P = 0.87; HR = 0.91, 95%CI = 0.82–1.01, P = 0.07). Subgroup analyses of RCTs or non-RCTs showed that OS and DFS remained statistically similar between hepatic resection with and without pre-operative TACE groups. Subgroup analysis of incomplete or no tumor necrosis showed that OS was worse in hepatic resection with pre-operative TACE group than in hepatic resection without pre-operative TACE group. By contrast, subgroup analysis of complete tumor necrosis showed that DFS was better in hepatic resection with pre-operative TACE group than in hepatic resection without pre-operative TACE group. Overall meta-analyses demonstrated that OS and DFS were better in hepatic resection with post-operative TACE group than in hepatic resection without post-operative TACE group (HR = 0.85, 95%CI = 0.72–1.00, P = 0.06; HR = 0.83, 95%CI = 0.73–0.94, P = 0.004). Subgroup analyses of RCTs, vascular invasion, or large HCC showed that OS and DFS remained better in hepatic resection with post-operative TACE group than in hepatic resection without post-operative TACE group. By contrast, subgroup analyses of non-RCTs, no vascular invasion, or small HCC showed that OS and DFS were statistically similar between the two groups. Conclusions Post-operative TACE, rather than pre-operative TACE, may be considered as an adjunctive treatment option for HCC treated with hepatic resection.

Prevalence of Splanchnic Vein Thrombosis in Pancreatitis: A Systematic Review and Meta-Analysis of Observational Studies

Splanchnic vein thrombosis (SVT) may be negatively associated with the prognosis of pancreatitis. We performed a systematic review and meta-analysis of literatures to explore the prevalence of SVT in pancreatitis. All observational studies regarding the prevalence of SVT in pancreatitis were identified via PubMed and EMBASE databases. The prevalence of SVT was pooled in the total of patients with pancreatitis. And it was also pooled in the subgroup analyses according to the stage and causes of pancreatitis, location of SVT, and regions where the studies were performed. After the review of 714 studies, 44 studies fulfilled the inclusion criteria. Meta-analyses showed a pooled prevalence of SVT of 13.6% in pancreatitis. According to the stage of pancreatitis, the pooled prevalence of SVT was 16.6% and 11.6% in patients with acute and chronic pancreatitis, respectively. According to the causes of pancreatitis, the pooled prevalence of SVT was 12.2% and 14.6% in patients with hereditary and autoimmune pancreatitis. According to the location of SVT, the pooled prevalence of portal vein, splenic vein, and mesenteric vein thrombosis was 6.2%, 11.2%, and 2.7% in pancreatitis. The prevalence of SVT in pancreatitis was 16.9%, 11.5%, and 8.5% in Europe, America, and Asia, respectively.

Clinical Outcomes of the Transplantation of Stem Cells from Various Human Tissue Sources in the Management of Liver Cirrhosis: A Systematic Review and Meta-Analysis

AIMS A systematic review and meta-analysis were performed to explore the clinical outcome of the transplantation of stem cells from various human tissue sources in cirrhotic patients. METHODS The relevant papers were searched via PubMed, EMBASE, and Cochrane Library databases. Changes in liver function before and after stem cell therapy were evaluated (self-control data). Difference in liver function and incidence of procedure-related complications, hepatocellular carcinoma (HCC), and death between patients undergoing stem cell therapy and conventional treatment were evaluated (case-control data). RESULTS Of 786 papers initially identified, 31 were included. The sources of stem cell included bone marrow (n=26), umbilical cord (n=3), peripheral blood (n=1), and human fetal liver (n=1). No severe procedure-related complications were reported. According to the meta- analyses of self-control data, model for end-stage liver diseases (MELD) score was significantly reduced at the 3rd-4th and 6th months after stem cell therapy, but this reduction was not statistically significant at the 1st-2nd or 12th postoperative months. Child-Pugh score was also reduced after stem cell therapy, but the reduction was not statistically significant at all follow-up time points. According to the meta-analyses of case-control data, MELD and Child-Pugh scores were not significantly different between treatment and control groups at all follow-up time points. The incidence of HCC was not significantly different between treatment and control groups (odds ratio [OR] to=0.41, P=0.53). The mortality was not significantly different between the two groups (OR=0.48, P=0.20). CONCLUSION Stem cell therapy could improve the liver function without any severe procedure-related complications. However, compared with conventional treatment, the benefit of stem cell therapy appeared to be not significant in improving the liver function and survival.

Associations of Antiphospholipid Antibodies With Splanchnic Vein Thrombosis: A Systematic Review With Meta-Analysis

AbstractSplanchnic vein thrombosis (SVT) refers to Budd–Chiari syndrome (BCS) and portal vein system thrombosis (PVST). Current practice guidelines have recommended the routine screening for antiphospholipid antibodies (APAs) in patients with SVT.A systematic review and meta-analysis of observational studies was performed to explore the association between APAs and SVT.The PubMed, EMBASE, and ScienceDirect databases were searched for all relevant papers, in which the prevalence of positive APAs or levels of APAs should be compared between BCS or noncirrhotic PVST patients versus healthy controls, or between cirrhotic patients with portal vein thrombosis (PVT) versus those without PVT.Fourteen studies were eligible. Only 1 study evaluated the role of APAs in BCS patients and found that positive immunoglobulin (Ig) G anticardiolipin antibody (aCL) was more frequently observed in BCS patients than in healthy controls; however, the associations of other APAs with BCS were not evaluated. Positive IgG aCL was more frequently observed in noncirrhotic patients with PVST than in healthy controls; however, other APAs, such as IgM aCL, lupus anticoagulants (LAs), anti-&bgr;2-glycoprotein-I antibody (a&bgr;2GPI), and a&bgr;2GPI-oxidized low-density lipoprotein antibody (ox-LDL) were not associated with noncirrhotic PVST. Positive unclassified aCL was more frequently observed in cirrhotic patients with PVT than in those without PVT; however, the association of IgG aCL and IgM aCL with the development of PVT in liver cirrhosis remained inconsistent among studies.The risk of BCS and noncirrhotic PVST might be increased by positive IgG aCL but not IgM aCL, LA, a&bgr;2GPI, or a&bgr;2GPI ox-LDL. However, the evidence regarding APAs in BCS originated from only 1 study. The association between APAs and PVT in liver cirrhosis was unclear.

Hepatic Re-resection Versus Transarterial Chemoembolization for the Treatment of Recurrent Hepatocellular Carcinoma after Initial Resection: a Systematic Review and Meta-analysis.

BACKGROUND A systematic review and meta-analysis were performed to compare the post-recurrence survival with hepatic re-resection versus transarterial chemoembolization (TACE) for recurrent hepatocellular carcinoma (HCC) after initial resection. MATERIALS AND METHODS All relevant papers were searched via PubMed, EMBASE, and Cochrane Library databases. Hazard ratios (HRs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Subgroup analysis was performed according to country. Sensitivity analysis was performed in studies which clearly reported the recurrent regions, in moderate/high-quality studies, in studies published in full-text form, and in studies published after 2005. RESULTS In total, twelve papers were included in our study. Five and seven of them were of moderate- and poor-quality, respectively. The overall meta-analysis demonstrated a statistically significantly higher post-recurrence survival in the hepatic re-resection group than in those undergoing TACE (HR=0.64, 95%CI=0.52-0.79, P<0.0001). Heterogeneity was statistically significant and statistical significance remained in the subgroup analysis. Sensitivity analyses were also consistent with the overall analysis. CONCLUSIONS Hepatic re-resection might provide a better post-recurrence survival than TACE for recurrent HCC after initial resection. However, considering the low quality of published studies and the potential bias of treatment selection, further randomized trials should be warranted to confirm these findings.

Clinical characteristics and outcomes of traditional Chinese medicine-induced liver injury: a systematic review

ABSTRACT Backgrounds: Traditional Chinese medicine (TCM) is becoming increasingly popular and related adverse events are often ignored or underestimated. Aims: This systematic review aimed to evaluate the clinical characteristics and outcomes of TCM-induced liver injury (TCM-ILI) and to estimate the proportion of TCM-ILI in all drug-induced liver injuries (DILI). Methods: China National Knowledge Infrastructure, Wanfang, VIP, PubMed, and Embase databases were searched. Demographic, clinical, and survival data were extracted and pooled. Factors associated with worse outcomes were calculated. For the proportion meta-analyses, the data were pooled by using a random-effects model. Results: Overall, 21,027 articles were retrieved, of which 625 were finally included. There was a predominance of female and older patients. The proportion of liver transplantation was 2.18% (7/321). The mortality was 4.67% (15/321). Male, higher aspartate aminotransferase and direct bilirubin, and lower albumin were significantly associated with an increased risk of death/liver transplantation in TCM-ILI patients. The proportion of TCM-ILI in all DILI was 25.71%. The proportion was gradually increased with year. Conclusions: Our work summarises current knowledge regarding clinical presentation, disease course, and prognosis of TCM-ILI. TCM can result in hepatotoxicity, even death or necessitate life-saving liver transplantation. Governmental regulation of TCM products should be strictly established.

Acid suppression in patients treated with endoscopic therapy for the management of gastroesophageal varices: A systematic review and meta-analysis

ABSTRACT Background and aim: Endoscopic therapy is the cornerstone choice for the management of varices and variceal hemorrhage. The aim of the present systematic review and meta-analysis was to evaluate the efficacy of acid suppression in patients treated with endoscopic therapy for gastroesophageal varices. Methods: All eligible studies were searched via the PubMed, EMBASE, and Cochrane Library databases. Incidence of bleeding, mortality, ulcers, chest pain, and dysphagia after endoscopic therapy and length of stay were analyzed. Subgroup analyses were performed according to the types and major indications of endoscopic treatments. Odds ratios (ORs) with 95% confidence intervals (95%CIs) were calculated. Results: Nine studies with 1470 patients were included. Acid suppression could significantly decrease the incidence of bleeding (OR = 0.39, 95%CI: 0.19–0.81, P = 0.01) and diminish the ulcer size (OR = 0.78, 95%CI: 0.38–1.57, P = 0.48) after endoscopic therapy. The subgroup analyses showed that acid suppression could significantly decrease the incidence of bleeding in patients undergoing prophylactic EVL, rather than in patients undergoing therapeutic EVL. There was no significant difference in the incidence of mortality, ulcers, chest pain, and dysphagia and length of stay between patients treated with and without acid suppression. Conclusion: Acid suppression might be considered in patients undergoing prophylactic EVL for gastroesophageal varices.