Prophylactic antibiotics in patients with alcohol-associated hepatitis receiving steroids: A systematic review and meta-analysis.

Autor: Quek JWE; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore., Loo JH; Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore, Singapore., Jaroenlapnopparat A; Department of Medicine, Mount Auburn Hospital, Boston, Massachusetts, USA., Jimenez C; Àrea de malalties digestives, Hospital Vall d'Hebron, Barcelona, Spain.; Department de Medicina, Facultat de Medicina, CIBERehD, Universitat Autònoma de Barcelona, Barcelona, Spain., Al-Karaghouli M; Liver Unit, Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada., Vargas V; Àrea de malalties digestives, Hospital Vall d'Hebron, Barcelona, Spain.; Department de Medicina, Facultat de Medicina, CIBERehD, Universitat Autònoma de Barcelona, Barcelona, Spain., Arab JP; Division of Gastroenterology, Department of Medicine, Schulich School of Medicine, Western University & London Health Sciences Centre, London, Ontario, Canada.; Department of Epidemiology and Biostatistics, Schulich School of Medicine, Western University, London, Ontario, Canada.; Departamento de Gastroenterologia, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile., Abraldes JG; Liver Unit, Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada., Wong YJ; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.; Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore, Singapore.; Liver Unit, Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada.
Jazyk: angličtina
Zdroj: Liver international : official journal of the International Association for the Study of the Liver [Liver Int] 2024 Sep; Vol. 44 (9), pp. 2469-2476. Date of Electronic Publication: 2024 Jun 22.
DOI: 10.1111/liv.16014
Abstrakt: Background & Aims: The benefits of prophylactic antibiotics in patients with alcohol-associated hepatitis (AH) receiving steroids remain unclear. We aimed to assess the clinical impact of prophylactic antibiotics in AH patients receiving steroids.
Methods: We systematically reviewed four electronic databases from inception to 30 November 2023. Pooled estimates were analysed using random-effects models. The primary outcome was 90-day survival. Secondary outcomes included infection at days 30 and 90 days, hepatorenal syndrome (HRS), acute kidney injury (AKI), hepatic encephalopathy (HE) and drug-related adverse events (AE). Trial sequential analyses were performed for the primary outcome of 90-day mortality.
Results: We screened 419 articles and included six eligible studies (four RCTs and two matched cohort studies) with a total of 510 patients. Compared to standard medical treatment (SMT), prophylactic antibiotics were associated with a lower risk of infection at 30 days (OR: 0.35, 95%CI: 0.20-0.59, I 2  = 0%), infection at 90 days (OR: 0.26, 95%CI: 0.10-0.67, I 2  = 0%) and a lower rate of HE (OR: 0.32, 95%CI: 0.12-0.87, I 2  = 0%). However, prophylactic antibiotics did not improve 90-day survival, sepsis-related mortality, HRS, or AKI. The risks of drug-related AE and fungal infections were similar in patients with AH who received prophylactic antibiotics or SMT. Using trial sequential analysis, the minimum sample size required to detect a 15% relative risk reduction in 90 days mortality with prophylactic antibiotics was 1171.
Conclusions: In hospitalized AH patients receiving steroid therapy, prophylactic antibiotics reduced the risk of infection and HE, but did not improve survival or prevent AKI compared to SMT.
(© 2024 The Author(s). Liver International published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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