医学
二甲双胍
肝硬化
失代偿
内科学
肝移植
危险系数
糖尿病
胃肠病学
科克伦图书馆
荟萃分析
移植
置信区间
内分泌学
胰岛素
作者
Spyros Peppas,Stavros Doumas,Advait Suvarnakar,Jiling Chou,Ayah Arafat,Akram I. Ahmad,James H. Lewis
标识
DOI:10.1097/meg.0000000000002754
摘要
Background Previous studies have demonstrated a beneficial effect of metformin in patients with cirrhosis, but no improvement in liver histology. Aim To investigate the impact of metformin on mortality and hepatic decompensation in people with diabetes with compensated cirrhosis. Methods Medline, Embase and Cochrane databases were searched from inception to February 2023 for studies reporting results regarding the impact of metformin on all-cause mortality and hepatic decompensation in people with diabetes with compensated cirrhosis. The risk of bias was assessed by ROBINS-I Cochrane tool. R software 4.3.1 was used for all analyses. Results Six observational studies were included in the final analysis. Metformin use was associated with reduced all-cause mortality or liver transplantation [hazard ratio (HR): 0.55; 95% confidence interval (CI) 0.37–0.82], while no benefit was shown in the prevention of hepatic decompensation (HR: 0.97; 95% CI: 0.77–1.22). In the subgroup analysis, metformin use was associated with reduced all-cause mortality or liver transplantation (HR: 0.50; 95% CI 0.38–0.65) in patients with metabolic-associated steatohepatitis cirrhosis, while two studies reported no survival benefit in patients with cirrhosis due to hepatitis C (HR: 0.39; 95% CI 0.12–1.20). Conclusion Metformin use is associated with reduced all-cause mortality, but not with the prevention of hepatic decompensation in people with diabetes with compensated cirrhosis. The mortality benefit is most likely driven by better diabetes and cardiovascular health control.
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