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. 2024 Mar 28:11:1379333.
doi: 10.3389/fmed.2024.1379333. eCollection 2024.

Probiotics are beneficial for liver cirrhosis: a systematic review and meta-analysis of randomized control trials

Xing Yang #  1 , Langhuan Lei #  1 , Wei Shi #  1 , Xiaozhen Li #  2 , Xiaozhi Huang  2 , Liuyan Lan  3 , Jiali Lin  1 , Qiuyu Liang  1 , Wei Li  2 , Jianrong Yang  1
Affiliations

Probiotics are beneficial for liver cirrhosis: a systematic review and meta-analysis of randomized control trials

Xing Yang et al. Front Med (Lausanne). .

Abstract

Introduction: Gut dysbiosis may play a pivotal role in the pathogenesis of cirrhosis and the severity of complications. Numerous studies have investigated the probiotics as treatments for cirrhosis. However, there is still a lack of definitive evidence confirming the beneficial effects of probiotics on cirrhosis.

Methods: Databases including PubMed, Embase, Web of Science, and the Cochrane Library were systematically searched for randomized controlled trials that compared the effects of probiotic intervention and control treatments, including placebo, no treatment, and active control, on cirrhosis, published from inception to February 2024. Outcomes included hepatic encephalopathy (HE) reversal, safety and tolerability of probiotics, liver function, quality of life, and other cirrhotic-related outcomes. A meta-analysis was conducted to synthesize evidence.

Results: Thirty studies were included. The quantitative synthesis results showed that compared with the control group, probiotics significantly reverse minimal hepatic encephalopathy (MHE) (risk ratio [RR] 1.54, 95% confidence interval [CI] 1.03 to 2.32) and improve HE (RR 1.94, 95% CI 1.24 to 3.06). Additionally, probiotics demonstrated higher safety and tolerability by causing a lower incidence of serious adverse events (RR 0.71, 95% CI 0.58 to 0.87). Probiotics could potentially improve liver function by reducing the Model for End-Stage Liver Disease (MELD) scores (standardized mean difference [SMD] -0.57, 95% CI -0.85 to -0.30), and displayed favorable changes in quality of life (SMD 0.51, 95% CI 0.27 to 0.75) and gut flora (SMD 1.67, 95% CI 1.28 to 2.06).

Conclusion: This systematic review and meta-analysis offers compelling evidence that probiotics are beneficial for cirrhosis by demonstrating reversal of HE, potential for liver function improvements, enhancements in quality of life, and regulation of gut dysbiosis. Furthermore, the apparent safety profile suggests that probiotics are a promising intervention for treating cirrhosis.

Clinical trial registration number: CRD42023478380.

Keywords: hepatic encephalopathy; liver cirrhosis; liver function; meta-analysis; probiotics.

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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.

Figures

Figure 1
Figure 1
Flow chart of the study selection procedure.
Figure 2
Figure 2
The effect of probiotics on the incidence of MHE and HE. Probiotics could promote MHE reversal and HE improvement.
Figure 3
Figure 3
The effect of probiotics on the ammonia level. There was a significant decrease in both venous and arterial ammonia level among the patients receiving probiotics.
Figure 4
Figure 4
The forest plot of neuropsychometric assessments. (A) DST; (B) NCT-A, NCT-B, FCT-A, FCT-B. Notable higher DST scores were shown in the probiotic group.
Figure 5
Figure 5
The forest plot of neurophysiological tests of P300 auditory event-related potential (P300ERP) and critical flicker frequency (CFF). A significant improvement in critical flicker frequency (CFF) was observed in the probiotic group.
Figure 6
Figure 6
The forest plot of the serious adverse events incidence. There was a significant lower incidence of overt HE, hospitalization, and infections among patients receiving probiotic treatment, compared with the control treatment.
Figure 7
Figure 7
The forest plot of the adverse events incidence. There was a significant lower incidence of ascites in the probiotic group, but no difference in the other adverse events such as abdominal pain, bloating, and constipation between groups.
Figure 8
Figure 8
The effect of probiotics in MELD scores. The probiotics could significantly reduced the MELD scores, compared with control treatment.
Figure 9
Figure 9
The forest plot of quality of life. The quality of life score of cirrhotic patients significantly improved in the probiotic group.
Figure 10
Figure 10
The effect of probiotics on gut flora. The numbers of Lactobacillus group were significantly increased.
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The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This work received support by funds from the Science and Technology Major Project of Guangxi (grant no. GuikeAA22096018), the Guangxi Key Research and Development Program (grant no. GuikeAB22080094), Natural Science Foundation of Guangxi Zhuang Autonomous Region (grant no. 2023GXNSFBA026187).

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