Postoperative steroid therapy for biliary atresia: Systematic review and meta-analysis

BACKGROUND: The role of adjuvant steroid therapy in the postoperative management of patients with biliary atresia (BA) is unclear.OBJECTIVE: To systematically review the literature and perform a meta-analysis to determine the efficacy of adjuvant steroid therapy post-Kasai portoenterostomy (KP) on BA outcome.METHODS: A systematic review and meta-analysis of randomized trials and/or observational studies that examined the role of steroids on BA outcomes published between January 1969 and June 2010 was conducted. Studies were identified using the Medline, PubMed, EMBASE and Cochrane databases.RESULTS: Sixteen observational studies and one randomized controlled trial (RCT) were found. Four of the 16 observational studies (160 participants) and the RCT (73 participants) met the entry criteria and were eligible to be included in the analysis. There was no statistically significant difference in the effect of steroids either on normalizing serum bilirubin levels at six months (pooled OR 1.48 [95% CI 0.67 to 3.28]) or in delaying the need for early liver transplantation (within the first year post-KP (pooled OR 0.59 [95% CI 0.21 to 1.72]).CONCLUSION: The present meta-analysis did not find a significant effect of steroid over standard therapy, either in normalizing serum bilirubin levels at six months or at delaying the need for early liver transplantation post-KP. RCT studies of sufficient size and comprehensive design using high-dose steroids are needed to determine the effectiveness of steroids on the short and intermediate post-KP outcomes for BA patients.

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Photobiomodulation Therapy/Photodynamic Therapy Versus Steroid Therapy for Oral Lichen Planus: A Systematic Review and Meta-Analysis

Photobiomodulation Photomedicine and Laser Surgery ◽

10.1089/photob.2020.4930 ◽

2021 ◽

Vol 39 (3) ◽

pp. 145-154

Author(s):

Bingjie Wang ◽

Jiayan Fan ◽

Liang Wang ◽

Luyi Chai

Keyword(s):

Systematic Review ◽

Photodynamic Therapy ◽

Lichen Planus ◽

Steroid Therapy ◽

Oral Lichen Planus ◽

Meta Analysis ◽

Photobiomodulation Therapy ◽

Oral Lichen

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Steroid therapy for COVID-19: A systematic review and meta-analysis of randomized controlled trials

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2021.1716 ◽

2021 ◽

Author(s):

Tarun Krishna Boppana ◽

Saurabh Mittal ◽

Karan Madan ◽

Anant Mohan ◽

Vijay Hadda ◽

...

Keyword(s):

Systematic Review ◽

Mechanical Ventilation ◽

Randomized Controlled Trials ◽

Steroid Therapy ◽

Meta Analysis ◽

Risk Of Bias ◽

Treatment Modalities ◽

Control Group ◽

Controlled Trials ◽

Randomized Controlled

There is an urgent need for effective treatment modalities for coronavirus disease 2019 (COVID-19). Data for the use of steroids in COVID-19 is emerging. We conducted this systematic review and meta-analysis to estimate the effectiveness of steroid administration in mortality reduction due to COVID-19 compared to the control group. A systematic search of the Pubmed and Embase databases was performed to extract randomized controlled trials (RCTs) regarding the use of steroid therapy for COVID-19. An overall and subgroup (based upon the type of steroid) pooled mortality analysis was performed, and odds ratios were reported. Cochrane risk of bias assessment tool was used to assess the risk of bias. Heterogeneity was assessed using the I2 statistic. Six RCTs, including 7707 patients, were selected for review. Three trials reported 28-day mortality, and two trials reported 21-day mortality, and one trial reported in-hospital mortality. There were 730 deaths among 2837 participants in the steroid group while 1342 deaths among 4870 patients randomized to the control group (Odds ratio 0.76, 95% confidence interval 0.58-1.00, p=0.05). The effect was significant in patients on oxygen or mechanical ventilation. There was no difference in the various preparations and doses of the steroids. There was heterogeneity among the trials as the I2 value was 53%, with a p-value of 0.06. There was no indication of increased serious adverse events. This meta-analysis of RCTs demonstrated that the use of systemic corticosteroids is associated with a reduction in all-cause mortality in patients with COVID-19 on oxygen or mechanical ventilation.

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Enhanced Steroid Therapy in Adult Minimal Change Nephrotic Syndrome: A Systematic Review and Meta-analysis

Internal Medicine ◽

10.2169/internalmedicine.54.3927 ◽

2015 ◽

Vol 54 (17) ◽

pp. 2101-2108 ◽

Cited By ~ 6

Author(s):

Lingfei Zhao ◽

Jun Cheng ◽

Jingyi Zhou ◽

Congcong Wu ◽

Jianghua Chen

Keyword(s):

Systematic Review ◽

Nephrotic Syndrome ◽

Steroid Therapy ◽

Meta Analysis ◽

Minimal Change Nephrotic Syndrome ◽

Minimal Change

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Efficacy and safety of steroid therapy in COVID-19: A rapid systematic review and Meta-analysis

Indian Journal of Pharmacology ◽

10.4103/ijp.ijp_1146_20 ◽

2020 ◽

Vol 52 (6) ◽

pp. 535

Author(s):

Bikash Medhi ◽

Phulen Sarma ◽

Anusuya Bhattacharyya ◽

Hardeep Kaur ◽

Manisha Prajapat ◽

...

Keyword(s):

Systematic Review ◽

Steroid Therapy ◽

Meta Analysis ◽

Efficacy And Safety

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Biomarkers for Diagnosis and Post-Kasai Portoenterostomy Prognosis of Biliary Atresia: Systematic Review and Meta-Analysis

10.21203/rs.3.rs-303189/v1 ◽

2021 ◽

Author(s):

Lin He ◽

Dennis Kai Ming Ip ◽

Greta Tam ◽

Vincent Chi Hang Lui ◽

Paul Kwong Hang Tam ◽

...

Keyword(s):

Systematic Review ◽

Liver Fibrosis ◽

Biliary Atresia ◽

Sensitivity And Specificity ◽

Meta Analysis ◽

Good Evidence ◽

Kasai Portoenterostomy ◽

Evidence Level ◽

Sensitivity Specificity ◽

Significant Liver Fibrosis

Abstract Objectives To evaluate the accuracy of biomarkers for the early diagnosis of biliary atresia (BA) and prognostic stratification after Kasai portoenterostomy (KPE). Methods We conducted a systematic review of PubMed, Web of Science, Embase, Scopus and OVID for English literatures reporting BA biomarkers published before August, 2020. Biomarkers selected for study was based on a good evidence-level (better than Grade B, level 2b). Screening, data extraction, and quality assessment were done in duplicate. Results A total of 51 eligible studies were involved for systematic review, and data from 12 of them (4182 subjects) were extracted for meta-analysis in the following 2 domains: (1) serum matrix metallopeptidase-7 (MMP-7), interleukin33 (IL-33) and γ-glutamyl transferase (GGT) to differentiate BA from non-BA; and (2) aspartate aminotransferase to platelet ratio index (APRi) to predict post-KPE liver fibrosis/cirrhosis. Summary sensitivity, specificity and the area under the curve (AUC) of MMP-7 for diagnosing BA were 96%, 91% and 0.9847, respectively. Summary sensitivity and specificity of IL-33 for diagnosing BA were 77% and 85%, respectively. Summary sensitivity, specificity and AUC of GGT for diagnosing BA were 80%, 79% and 0.9645, respectively. Summary sensitivity and specificity of APRi for predicting post-KPE liver fibrosis were 61% and 80%, respectively. Summary sensitivity, specificity and AUC of APRi for predicting post-KPE cirrhosis were 78%, 83% and 0.8729, respectively. Moreover, good evidence-level was shown in the investigations of serum IL-18 and IL-33 in distinguishing BA from healthy control, serum IL-18 for prognosing post-KPE persistent jaundice, and serum hyaluronic acid and MMP-7 for prognosing post-KPE significant liver fibrosis. Conclusions MMP-7, IL-33 and GGT are useful biomarker to assist the diagnosis of BA. APRi could be used to predict post-KPE significant liver fibrosis and cirrhosis. These non-invasive biomarkers could be integrated into the management protocol of BA.

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