The Efficacy and Safety of Glucocorticoids Plus Conventional Therapy for Hepatitis B-Related Liver Failure in China: A Meta-Analysis

Context: The aim of this meta-analysis was to evaluate the efficacy and safety of glucocorticoid plus conventional therapy in hepatitis B-related liver failure. Evidence Acquisition: A systematic search was performed in PubMed, Embase, the Cochrane library, China National Knowledge Infrastructure, Wanfang database, and Google Scholar. The primary outcome was improvement in the mortality rate and the secondary outcome was the incidence of complications. Pooled data were based on the fixed-effect model. Results: Ten studies with 891 patients were included in the meta-analysis. Glucocorticoid plus conventional therapy (OR = 3.98, 95% CI: 2.80 - 5.66; P = 0.000) was superior to conventional treatment alone and reduced the mortality rate (OR = 0.38, 95% CI [0.20, 0.74], P = 0.004). Moreover, the incidence of complications, such as hepatic encephalopathy (OR = 0.34, 95% CI [0.19, 0.60], P = 0.000), hepatorenal syndrome (OR = 0.22, 95% CI [0.10, 0.47], P = 0.000), electrolyte imbalance (OR = 0.27, 95% CI [0.12, 0.62], P = 0.002), and ascites (OR = 0.50, 95% CI [0.28, 0.90], P = 0.021), were reduced. No statistically significant differences were found between the two groups in terms of lung infection (OR = 0.76, 95% CI [0.27, 2.10], P = 0.595), gastrointestinal bleeding (OR = 0.48, 95% CI [0.23, 1.00], P = 0.050), and bacterial peritonitis (OR = 0.70, 95% CI [0.31, 1.58], P = 0.396). Conclusions: Our meta-analysis suggests that glucocorticoid plus conventional treatment reduced the incidence of complications. Thus combination therapy could be an effective and safe approach in treating patients with hepatitis B-related liver failure.