Objective:Emerging evidence suggest that antibiotic prophylaxis may be omitted in early cirrhosis patients with upper gastrointestinal bleeding(UGIB),which question the benefits of antibiotic prophylaxis on rebleeding...Objective:Emerging evidence suggest that antibiotic prophylaxis may be omitted in early cirrhosis patients with upper gastrointestinal bleeding(UGIB),which question the benefits of antibiotic prophylaxis on rebleeding,mortality related to ongoing bleeding,and the need for salvage therapy.As the management of UGIB has improved over time since the last review a decade ago,we performed an updated meta‐analysis to review the benefits of antibiotic prophylaxis in cirrhosis patients with UGIB.Method:Six electronic databases including PubMed/MEDLINE,EMBASE,Scopus,Web of Science,Cochrane library,and ClinicalTrial.gov were systematically searched up to December 1,2021.The primary outcome was 6 weeks mortality.Secondary outcomes include the risk of infection,rebleeding at 7 days and 6 weeks,mortality related to ongoing bleeding,need for salvage therapy,and infection‐related mortality.Result:Eighteen studies(12 randomized controlled trials[RCT],6 non‐RCT)from 3180 subjects were identified among 2129 citations.Antibiotic prophylaxis reduces mortality at 6 weeks,risk of infection,and infectionrelated mortality(pooled relative risk:0.72,0.39,and 0.41,respectively).Although antibiotics reduce the risk of rebleeding and the amount of blood transfusion,they did not reduce the risk of mortality from ongoing bleeding nor the need for salvage therapy.Antibiotic prophylaxis may shorten the length of stay in the intensive care unit.Conclusion:Antibiotic prophylaxis reduces rebleeding,6‐week mortality,and infection‐related mortality.Due to the low risk of infection and death,dedicated studies are warranted to evaluate the benefit of antibiotic prophylaxis in early cirrhosis with UGIB.展开更多
Introduction Liver cirrhosis is characterized by a delicate balance between thrombosis and bleeding.Parenchymal extinction due to microvascular thrombosis is involved in disease progression and anticoagulant therapy w...Introduction Liver cirrhosis is characterized by a delicate balance between thrombosis and bleeding.Parenchymal extinction due to microvascular thrombosis is involved in disease progression and anticoagulant therapy with low-molecular-weight heparin has been shown to reduce the frequency of hepatic decompensation[1].Dysbiosis and bacterial translocation,which are hallmarks of liver cirrhosis,can influence the coagulation system through inflammation or by the activation of Toll-like receptors on endothelial cells and platelets[2].However,little is known about the connections between the coagulation system,the occurrence of liver cirrhosis complications,and the gut microbiome.展开更多
文摘Objective:Emerging evidence suggest that antibiotic prophylaxis may be omitted in early cirrhosis patients with upper gastrointestinal bleeding(UGIB),which question the benefits of antibiotic prophylaxis on rebleeding,mortality related to ongoing bleeding,and the need for salvage therapy.As the management of UGIB has improved over time since the last review a decade ago,we performed an updated meta‐analysis to review the benefits of antibiotic prophylaxis in cirrhosis patients with UGIB.Method:Six electronic databases including PubMed/MEDLINE,EMBASE,Scopus,Web of Science,Cochrane library,and ClinicalTrial.gov were systematically searched up to December 1,2021.The primary outcome was 6 weeks mortality.Secondary outcomes include the risk of infection,rebleeding at 7 days and 6 weeks,mortality related to ongoing bleeding,need for salvage therapy,and infection‐related mortality.Result:Eighteen studies(12 randomized controlled trials[RCT],6 non‐RCT)from 3180 subjects were identified among 2129 citations.Antibiotic prophylaxis reduces mortality at 6 weeks,risk of infection,and infectionrelated mortality(pooled relative risk:0.72,0.39,and 0.41,respectively).Although antibiotics reduce the risk of rebleeding and the amount of blood transfusion,they did not reduce the risk of mortality from ongoing bleeding nor the need for salvage therapy.Antibiotic prophylaxis may shorten the length of stay in the intensive care unit.Conclusion:Antibiotic prophylaxis reduces rebleeding,6‐week mortality,and infection‐related mortality.Due to the low risk of infection and death,dedicated studies are warranted to evaluate the benefit of antibiotic prophylaxis in early cirrhosis with UGIB.
基金supported by“Ministero della Salute–Ricerca Corrente 2022”.
文摘Introduction Liver cirrhosis is characterized by a delicate balance between thrombosis and bleeding.Parenchymal extinction due to microvascular thrombosis is involved in disease progression and anticoagulant therapy with low-molecular-weight heparin has been shown to reduce the frequency of hepatic decompensation[1].Dysbiosis and bacterial translocation,which are hallmarks of liver cirrhosis,can influence the coagulation system through inflammation or by the activation of Toll-like receptors on endothelial cells and platelets[2].However,little is known about the connections between the coagulation system,the occurrence of liver cirrhosis complications,and the gut microbiome.