Effects of Statins on the Hepatic Decompensation, Mortality, Complications and Drug Safety in Liver Cirrhosis: A Systematic Review and Meta-Analysis

Background and Aim: Evidence indicates statins seem to improve outcomes in cirrhotic patients. Systematic review and meta-analysis are performed to evaluate the effect and safety of statins in the setting of cirrhosis. Methods: We searched PubMed, EMBASE, and the Cochrane Library from inception through January 2018 to identify comparative studies evaluating the role of statins in cirrhosis. Pooled risk estimates with 95% confidence intervals were calculated using a random effects model. Results: Eight studies (4 retrospective cohort studies and 4 randomized controlled trials) involving 3,966 cirrhotic patients were included. Statin use was associated with 56% lower risk of progression to decompensated cirrhosis (RR, 0.44; 95% CI, 0.36–0.54) and 47% lower risk of mortality (RR, 0.53; 95% CI, 0.47–0.61). Subgroup analyses showed that these results were generally consistent regardless of study design, etiology of cirrhosis, stage of cirrhosis, follow-up time, method of identifying cirrhosis. For initial variceal bleeding, pooled RR was 0.48 (0.35–0.67). For ascites, pooled RR was 0.66 (0.45–0.99). For portal hypertension, using statins could increase the HVPG response rate, pooled RR was 2.61(1.03–6.62). For hepatocellular carcinoma, pooled RR was 0.47(0.36–0.63). For any adverse event and serious adverse events, using statins was almost equivalent to nonusers, pooled RR was 1.06 (0.50-2.25) and 0.77 (0.31–1.95). Conclusions: Statin use may be associated with reduced risk of hepatic decompensation and mortality in cirrhosis with well tolerated. Additionally, statin use appears to decrease portal hypertension and reduce the risk of initial variceal bleeding, ascites and hepatocellular carcinoma. Further RCTs will be required to confirm our findings.