Do gut microbiome‐targeted therapies improve liver function in cirrhotic patients? A systematic review and meta‐analysis

Abstract Background and Aim Microbiome‐targeted therapies (MTTs) are considered as promising interventions for cirrhosis, but the impact of gut microbiome modulation on liver function and disease severity has not been fully assessed. We comprehensively evaluated the efficacy of MTTs in patients with liver cirrhosis. Methods Data from randomized controlled trials were collected through MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and ClinicalTrial.gov from inception to February 20, 2023. Clinical outcomes were pooled and expressed in terms of risk ratios or mean differences (MD). Additional subgroup and sensitivity analyses were performed to validate the robustness of findings. A trial sequential analysis was applied to calculate the required information size and evaluate the credibility of the meta‐analysis results. Results Twenty‐one studies with a total of 1699 cirrhotic patients were included for meta‐analysis. MTTs were associated with a significant reduction in aspartate aminotransferase (MD, −3.62; 95% CI, −6.59 to −0.65), the risk of hepatic encephalopathy (risk ratio = 0.56, 95% CI: 0.46 to 0.68), model for end‐stage liver disease score (MD, −0.90; 95% CI, −1.17 to −0.11), ammonia (MD, −11.86; 95% CI, −16.39 to −7.33), and endotoxin (MD, −0.14; 95% CI, −0.23 to −0.04). The trial sequential analysis yielded reliable results of these outcomes. No effects were observed on the changes of other hepatic function indicators. Conclusion MTTs appeared to be associated with a slowed deterioration in liver cirrhosis, which could provide reference for clinicians in treatment of cirrhotic patients based on their conditions.