Statin Use and Risk of Cirrhosis and Related Complications in Patients With Chronic Liver Diseases: A Systematic Review and Meta-analysis  Rebecca G. Kim, Rohit Loomba, Larry J. Prokop, Siddharth Singh  Clinical Gastroenterology and Hepatology  Volume 15, Issue 10, Pages 1521-1530.e8 (October 2017) DOI: 10.1016/j.cgh.2017.04.039 Copyright © 2017 AGA Institute Terms and Conditions

Figure 1 Study selection flowsheet. NASH, nonalcoholic steatohepatitis. Clinical Gastroenterology and Hepatology 2017 15, 1521-1530.e8DOI: (10.1016/j.cgh.2017.04.039) Copyright © 2017 AGA Institute Terms and Conditions

Figure 2 Forest plot showing the association between statin exposure and risk of progression of fibrosis or development of cirrhosis. Clinical Gastroenterology and Hepatology 2017 15, 1521-1530.e8DOI: (10.1016/j.cgh.2017.04.039) Copyright © 2017 AGA Institute Terms and Conditions

Figure 3 Forest plot showing the association between statin exposure and risk of decompensation of cirrhosis. Of note, on restricting analysis only to patients with baseline compensated cirrhosis (excluding patients with noncirrhotic CLDs in Huang et al), a similar protective association between statin use and risk of hepatic decompensation was observed (RR, 0.54; 95% CI, 0.44–0.66). Clinical Gastroenterology and Hepatology 2017 15, 1521-1530.e8DOI: (10.1016/j.cgh.2017.04.039) Copyright © 2017 AGA Institute Terms and Conditions

Figure 4 Forest plot showing the association between statin exposure and risk of all-cause mortality. On restricting analysis only to patients with baseline cirrhosis (excluding patients with noncirrhotic CLDs),42 a similar protective association was observed (RR, 0.54; 95% CI, 0.47–0.61), with minimal heterogeneity (I2 = 10%). Clinical Gastroenterology and Hepatology 2017 15, 1521-1530.e8DOI: (10.1016/j.cgh.2017.04.039) Copyright © 2017 AGA Institute Terms and Conditions

Figure 5 Forest plot showing the association between statin exposure and risk of progression of portal hypertension. Clinical Gastroenterology and Hepatology 2017 15, 1521-1530.e8DOI: (10.1016/j.cgh.2017.04.039) Copyright © 2017 AGA Institute Terms and Conditions

Supplementary Figure 1 Methodological quality of RCTs. In the Cochrane Risk of Bias tool, studies were deemed to be at high (red), low (green) or unclear (yellow) risk of bias based on adequacy of sequence generation, allocation concealment, blinding, method of addressing incomplete data, selective reporting, and other biases. The review authors’ judgments about each risk of bias item are presented for each included study. +, low risk of bias; ?, unclear risk. Clinical Gastroenterology and Hepatology 2017 15, 1521-1530.e8DOI: (10.1016/j.cgh.2017.04.039) Copyright © 2017 AGA Institute Terms and Conditions