Cochrane · systematic review · CD008716
Probiotics for people with hepatic encephalopathy
Dalal, R, McGee, RG, Riordan, SM, et al. · Cochrane Database of Systematic Reviews · 2017 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
12
current version
GRADE rated
12
No studies
0
Included studies
NR
No studies 0 · 0%Ungraded 0 · 0%Very low 7 · 58.3%Low 4 · 33.3%Moderate 1 · 8.3%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Current version onlyProbiotic for people with hepatic encephalopathy
Population: people with hepatic encephalopathy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause mortality ( | RR 0.58 [0.23, 1.44] | 7 studies · 404 participants | Low Downgraded: risk of bias, imprecision |
No‐recovery (incomplete resolution of clinical symptoms) ( | RR 0.67 [0.56, 0.79] | 10 studies · 574 participants | Moderate Downgraded: risk of bias |
Adverse events ‐ Overt hepatic encephalopathy ( | RR 0.29 [0.16, 0.51] | 10 studies · 585 participants | Low Downgraded: risk of bias, imprecision |
Adverse events ‐ Change of/or withdrawal from treatment ( | RR 0.7 [0.46, 1.07] | 9 studies · 551 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Quality of life ( | no estimate extracted | 3 studies · 115 participants | Low Downgraded: risk of bias, imprecision |
Plasma ammonia concentration (final and change scores) (μmol/L) ( | no estimate extracted | 10 studies · 705 participants | Low Downgraded: risk of bias, inconsistency |
Probiotics for people with hepatic encephalopathy
Population: people with hepatic encephalopathy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause mortality ( | RR 5 [0.25, 102] | 2 studies · 200 participants | Very low Downgraded: risk of bias, imprecision |
No‐recovery (incomplete resolution of clinical symptoms) ( | RR 1.01 [0.85, 1.21] | 7 studies · 430 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Adverse events ‐ Overt hepatic encephalopathy ( | RR 1.17 [0.63, 2.17] | 6 studies · 420 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Adverse events ‐ Change of/or withdrawal from treatment ( | RR 1.27 [0.88, 1.82] | 7 studies · 490 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Quality of life ( | no estimate extracted | 1 study · 69 participants | Very low Downgraded: risk of bias, imprecision |
Plasma ammonia concentration (final and change scores) (μmol/L) ( | no estimate extracted | 6 studies · 325 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Probiotic versus placebo/ no intervention for patients with hepatic encephalopathy
Population: patients with patients with hepatic encephalopathy.
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All cause mortality Probiotic vs placebo/ no intervention | RR 0.72 [0.08, 6.6] | 2 studies · 105 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
No recovery (incomplete resolution of clinical symptoms) Probiotic vs placebo/ no intervention | RR 0.72 [0.49, 1.05] | 4 studies · 206 participants | Low Downgraded: risk of bias, imprecision |
Number of adverse events Probiotic vs placebo/ no intervention | RR 0.34 [0.08, 1.42] | 3 studies · 145 participants | Low Downgraded: risk of bias, imprecision |
Quality of life SF‐36 physical/ mental Probiotic vs placebo/ no intervention | no estimate extracted | 1 study · 40 participants | Low Downgraded: risk of bias, imprecision |
Change of/or withdrawal from treatment Probiotic vs placebo/ no intervention | RR 1.28 [0.52, 3.19] | 3 studies · 175 participants | Low Downgraded: risk of bias, imprecision |
Plasma ammonia concentration (µmol/L) Probiotic vs placebo/ no intervention | no estimate extracted | 3 studies · 226 participants | Very low Downgraded: risk of bias, inconsistency, indirectness |
Change in plasma ammonia concentration (µmol/L) Probiotic vs placebo/ no intervention | no estimate extracted | 1 study · 73 participants | Ungraded |
Probiotic versus lactulose for hepatic encephalopathy
Population: patients with hepatic encephalopathy.
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
No recovery (incomplete resolution of clinical symptoms) Probiotic vs lactulose | RR 1.05 [0.75, 1.47] | 3 studies · 173 participants | Low Downgraded: risk of bias, inconsistency |
Number of adverse events Probiotic vs lactulose | RR 0.57 [0.06, 5.74] | 2 studies · 111 participants | Low Downgraded: risk of bias, imprecision |
Change of/or withdrawal from treatment Probiotic vs lactulose | RR 1.1 [0.4, 3.03] | 3 studies · 190 participants | Low Downgraded: risk of bias, imprecision |
Plasma ammonia concentration (µmol/L) Probiotic vs lactulose | no estimate extracted | 2 studies · 93 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Change in plasma ammonia concentration (µmol/L) Probiotic vs lactulose | no estimate extracted | 1 study · 77 participants | Very low Downgraded: risk of bias, imprecision, indirectness |