Meta-analysis Of Efficacy And Safety Of Glucocorticoids In The Treatment Of Patients With HBV Related Acute-on-chronic Liver Failure

Objective:To systematically evaluate the efficacy and safety of glucocorticoids in the treatment of patients with HBV related acute-on-chronic liver failure,and to provide evidence-based evidence for clinical research.Methods:Databases such as Cochrane Library,Embase,Pub Med,CNKI,VIP,and Wan Fang were searched in English and Chinese,and the search period was from database creation to November 2022.Randomized controlled trials(RCTs)of glucocorticoids for HBV related acute-on-chronic liver failure(HBV-ACLF)were searched.Rev Man5.4 was used for analysis and evaluation.Results:A total of 1261 patients with HBV-ACLF were included in 14 literatures.Meta-analysis results showed that glucocorticoids combined with conventional treatment improved the overall efficiency of treatment in patients with HBV-ACLF(OR=3.99,95%CI: 2.61-6.11,P<0.00001)and reduced the case fatality rate(OR=0.53,95% CI: 0.34-0.83,P=0.005),and did not affect the HBV-DNA negative rate(OR=1.08,95% CI: 0.54-2.18,P=0.82).In terms of complications,the incidence of secondary infections,hepatorenal syndrome and gastrointestinal bleeding were lower in the experimental group than in the control group,and the differences were statistically significant(P < 0.05),and the difference in the incidence of hepatic encephalopathy between the two groups was not statistically significant(OR = 0.64,95% CI: 0.25-1.66,P = 0.36).Regarding the laboratory indexes,the improvement of serum TBIL,ALT,PTA and ALB level were better in the experimental group than in the control group,but the difference between the two groups in the improvement of AST was not statistically significant(SMD=-2.637,95% CI:-6.830,1.557,P=0.218).Conclusions:In patients with HBV-ACLF,glucocorticoid use improves the efficiency of treatment,reduces the case fatality rate,improves key laboratory parameters,and does not increase the incidence of complications,and does not affect HBV-DNA negative rates.Glucocorticoids in combination with conventional therapy are expected to be a safe and effective treatment for HBV-ACLF.