Effect of zinc treatment on clinical outcomes in patients with liver cirrhosis:A systematic review and meta-analysis

摘要

BACKGROUNDZinc is an essential trace element integral to many cellular and immune functions.Zinc deficiency is highly prevalent in patients with cirrhosis and related to diseaseseverity.AIMTo evaluate whether zinc supplementation improves clinical outcomes (diseaseseverity and mortality) in patients with cirrhosis.METHODSThis prospectively registered systematic review (PROSPERO reference:CRD42018118219) included all studies in Medline, Embase or Cochrane databasewith inclusion criteria of adult human studies, comparing zinc supplementationof at least 28 d with standard care or placebo in patients with cirrhosis. Mortalityand clinical severity score data were extracted. Random effects meta-analysescompared mortality at 6 mo and 2 years. Risk of bias was assessed using theNational Institutes of Health quality assessment tool.RESULTSSeven hundred and twelve articles were identified of which four were eligible.Zinc formulations and doses varied (elemental zinc 3.4-214 mg daily) for different intervention periods in patients with differing etiology and severity of cirrhosis.Two studies were considered to be at high risk of bias. There was no significantdifference in 6-mo mortality between patients treated with zinc versus controls[risk ratio 0.98 (0.90-1.05)]. Changes in severity scores were not reported in anystudy.CONCLUSIONZinc supplementation is not associated with reduced mortality in patients withcirrhosis. Findings are limited by the small number of eligible studies andsignificant heterogeneity in intervention and patient population.