Role of rifaximin in the management of alcohol-associated hepatitis: A systematic review and meta-analysis

被引:6
作者
Ahmed, Zohaib [1 ]
Badal, Joyce [2 ]
Nawras, Mohamad [2 ]
Battepati, Dhanushya [2 ]
Farooq, Umer [5 ]
Arif, Syeda Faiza [9 ]
Lee-Smith, Wade [3 ]
Aziz, Muhammad [4 ]
Iqbal, Umair [6 ]
Nawaz, Ahmad [7 ]
Gangwani, Manesh Kumar [1 ]
Iqbal, Amna [1 ]
Kobeissy, Abdallah
Addissie, Benyam D. [6 ]
Hassan, Mona
Saab, Sammy [8 ]
机构
[1] Univ Toledo, Dept Internal Med, Med Ctr, Toledo, OH 43614 USA
[2] Univ Toledo, Coll Med & Life Sci, Toledo, OH USA
[3] Univ Toledo Lib, Toledo, OH USA
[4] Univ Toledo, Dept Gastroenterol & Hepatol, Toledo, OH USA
[5] Loyola Med MacNeal Hosp, Dept Internal Med, Berwyn, IL USA
[6] Geisinger Med Ctr, Dept Gastroenterol & Hepatol, Danville, PA USA
[7] Yale New Haven Hosp, New Haven, CT USA
[8] UCLA Univ Calif Los Angeles, David Geffen Sch Med, Dept Med & Surg, Los Angeles, CA USA
[9] Dow Med Univ, Karachi, Pakistan
关键词
alcohol-associated hepatitis; gastrointestinal bleeding; hepatic failure; sepsis; EARLY LIVER-TRANSPLANTATION; LONG-TERM; ENCEPHALOPATHY; PREDNISOLONE; INFECTION; GUIDELINE; MORTALITY; IMPACT;
D O I
10.1111/jgh.16179
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background and AimAlcohol-associated hepatitis (AAH) is an acute, inflammatory liver disease with severe short-term and long-term morbidity and mortality. AAH can lead to severe complications including hepatic failure, gastrointestinal bleeding, sepsis, and the development or decompensation of cirrhosis. Rifaximin is an antibiotic that reduces bacterial overgrowth and gut translocation, and it may have a role in decreasing systemic inflammation and infection in patients with AAH. Therefore, we conducted a systematic review and meta-analysis to evaluate the role of rifaximin in the management of AAH. MethodsA comprehensive search strategy was used to identify studies that met our inclusion criteria in Embase, MEDLINE (PubMed), Cochrane Library, Web of Science Core Collection, and Google Scholar. Outcomes of interest included rates of infection, 90-day mortality, and overall mortality between the rifaximin versus non-rifaximin group. Open Meta Analyst software was used to compute the results. ResultsThree studies with a total of 162 patients were included in the final meta-analysis. Of the three studies, two were randomized control trials (RCTs), and one was a case-control study. There was a significantly lower rate of infection in the rifaximin group versus the non-rifaximin group (RR: 0.331, 95% CI: 0.159-0.689, I-2 = 0%, P = 0.003). There was no significant difference in 90-day mortality in the rifaximin versus non-rifaximin group (RR: 0.743, 95% CI: 0.298-1.850, I-2 = 24%, P = 0.523), nor was there a significant difference in overall mortality (RR: 0.624, 95% 95% CI: 0.299-1.3, I-2 = 7.1%, P = 0.208). ConclusionsThe use of rifaximin in AAH is associated with a lower rate of infection rate than the non-rifaximin group. Additional research is needed to determine whether this effect is more pronounced in patients concurrently being treated with prednisolone. Differences in 90-day or overall mortality did not reach statistical significance. Further studies, particularly large randomized controlled trials, are needed to establish the role of rifaximin in AAH, especially as an adjunct therapy with prednisolone.
引用
收藏
页码:703 / 709
页数:7
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