Efficacy of glucocorticoid in treatment of HBV-related hepatic failure: a meta-analysis

Objective To evaluate the therapeutic effect of glucocorticoid in the treatment of HBV-related hepatic failure. Methods Literature was retrieved from Medline, PubMed, EMbase, OUP, Elesiver, BIOSIS, HMIC, CNKI, VIP, WANFANG Database and CBM Database from Jan. 1989 to Jan. 2012 to collect the papers concerning the clinical trials (published in English and Chinese) referring to glucocorticoid treatment and routine treatment for hepatic failure by meta-analysis method. Weighted mean (WM) was applied to evaluate the effect of glucocorticoid on prothrombin time (PT) and total bilirubin (TBil), and odds ratio (OR) was applied to evaluate the effect of glucocorticoid on survival rate, secondary infection and alimentary tract hemorrhage. Results Above-mentioned indexes included 24, 6, 9, 10, and 9 related articles. The effective indexes and 95% confidence interval (CI) were 3.12 (95%CI: 2.53-3.86), –0.48 (95%CI: –0.71-–0.25), –1.01 (95%CI: –1.29-–0.73), 0.80 (95%CI: –0.58-1.10) and 0.59 (95%CI: –0.41-0.85), respectively. Treatment with glucocorticoid decreased the mortality of patients with hepatic failure (Z=10.37, P=0.000), and improved PT and TBil levels (Z=4.10, P=0.000; Z=7.07, P=0.000), but no change was found in incidence of secondary infection and alimentary tract hemorrhage (Z=1.39, P=0.165; Z=1.69, P=0.095). Conclusion Glucocorticoid shows an obvious effect on the prognosis of patients with hepatic failure with no increase in complications.