Efficacy and Safety of Treatments for Patients With Portal Hypertension and Cirrhosis: A Systematic Review and Bayesian Network Meta-Analysis

Qigu Yao, Wenyi Chen, Cuilin Yan, Jiong Yu, Tian'an Jiang, Hongcui Cao, Qigu Yao, Wenyi Chen, Cuilin Yan, Jiong Yu, Tian'an Jiang, Hongcui Cao

Abstract

Background and Aims: Viral hepatitis are one of the main causes of liver cirrhosis. The treatment of portal hypertension caused by liver cirrhosis is difficult and diverse, and the therapeutic effect is unknown. Bayesian network meta-analysis was performed to compare the efficacy and safety of treatments for patients with portal hypertension and cirrhosis, including a transjugular intrahepatic portosystemic shunt (TIPS), endoscopic therapy, surgical therapy and medications. Methods: Eligible articles were searched for in PubMed, Embase, Cochrane Library and Web of Science databases from their inception until June 2020. Using the "gemtc-0.8.4" package in R v.3.6.3 software and the Just Another Gibbs Sampler v.4.2.0 program, network meta-analysis was performed using a random effects model within a Bayesian framework. The odds ratios for all-cause rebleeding, bleeding-related mortality, overall survival (OS), treatment failure and hepatic encephalopathy were determined within the Bayesian framework. Results: Forty randomized controlled trials were identified, including 4,006 adult patients and nine treatment strategies. Our results showed that distal splenorenal shunt and TIPS provided the best control of hemorrhage. Endoscopic variceal ligation with medication resulted in the highest OS rate. Medication alone resulted in poor OS and treatment failure. Conclusions: We performed a systematic comparison of diverse treatments for cirrhotic patients with portal hypertension. Our meta-analysis indicated that a TIPS and distal splenorenal shunt resulted in lower rates of rebleeding than did other therapies. Furthermore, drugs are more suitable for combination therapy than monotherapy.

Keywords: all-cause rebleeding; endoscopic therapy; liver cirrhosis; network meta-analysis; portal hypertension; transjugular intrahepatic portosystemic shunt.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Yao, Chen, Yan, Yu, Jiang and Cao.

Figures

Figure 1
Figure 1
Flow chart of the study selection.
Figure 2
Figure 2
Network structure diagrams. As shown in the figure, the thickness of the lines is proportional to the number of comparisons, and the diameter of the circles is proportional to the number of treatments included in the meta-analysis. (A) All-cause rebleeding. Rebleeding at (B) 1 year, (C) 2 years, and (D) 3 years. (E) Treatment failure. (F) Bleeding-related mortality. OS at (G) 1 year, (H) 2 years, and (I) 3 years. (J) Hepatic encephalopathy.
Figure 3
Figure 3
Forest plot of the odds ratios for all-cause rebleeding based on different pairwise comparisons. EVL, endoscopic variceal ligation; TIPS, transjugular intrahepatic portosystemic shunt; DSRS, distal splenorenal shunt; EIS, endoscopic injection sclerotherapy; ETA, endoscopic tissue.
Figure 4
Figure 4
Ranking of therapies based on all-cause rebleeding. EVL, endoscopic variceal ligation; TIPS, transjugular intrahepatic portosystemic shunt; DSRS, distal splenorenal shunt; EIS, endoscopic injection sclerotherapy; ETA, endoscopic tissue.
Figure 5
Figure 5
Forest plot of the odds ratios for 1-year OS based on different pairwise comparisons. EVL, endoscopic variceal ligation; TIPS, transjugular intrahepatic portosystemic shunt; DSRS, distal splenorenal shunt; EIS, endoscopic injection sclerotherapy; ETA, endoscopic tissue.
Figure 6
Figure 6
Ranking of 1-year OS among the different therapies. EVL, endoscopic variceal ligation; TIPS, transjugular intrahepatic portosystemic shunt; DSRS, distal splenorenal shunt; EIS, endoscopic injection sclerotherapy; ETA, endoscopic tissue.
Figure 7
Figure 7
Ranking of the odds ratios for HE based on different pairwise comparisons. EVL, endoscopic variceal ligation; TIPS, transjugular intrahepatic portosystemic shunt; DSRS, distal splenorenal shunt; EIS, endoscopic injection sclerotherapy; ETA, endoscopic tissue.

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