Can probiotics improve liver and kidney function in cirrhosis? A grade assessed meta-analysis of randomized trials

Liver cirrhosis is accompanied with several disrupted biochemical markers. In this context, probiotics share more beneficial properties through gut microbiome modulation. This study aimed to evaluate the efficacy of probiotics on cirrhosis-associated outcomes among patients with cirrhosis. A comprehensive systematic search was performed in PubMed, Scopus, Web of Science, and google scholar databases. We included randomized controlled trials (RCTs) that examined the efficacy of probiotics across liver and kidney variables among cirrhosis patients. The systematic search process retrieved 16 records. This study demonstrated that probiotic intervention is associated with significant reduction on ammonia among cirrhosis patients (SMD: -1.07, 95% CI: -1.71, -0.42; P = 0.002). Notably, this beneficial effect was highlighted by using multi-strain and log-term administration. In contrast, probiotics failed to exert beneficial effects on alanine aminotransferase (ALT) (SMD: -0.29, 95% CI: -0.96, 0.38; P = 0.398), aspartate aminotransferase (AST) (SMD: -0.14, 95% CI: -0.95, 0.68; P = 0.743), international normalized ratio (INR) (SMD: -0.10, 95% CI: -1.20, 0.99; P = 0.853), albumin (SMD: 0.19, 95% CI: -0.22, 0.61; P = 0.366), and bilirubin (SMD: -0.38, 95% CI: -0.82, 0.06; P = 0.087). Similarly, this intervention was not potent enough to exhibit favorable effects on creatinine level too (SMD: 0.14, 95% CI: -0.16, 0.44; P = 0.362). Probiotic supplementation contributed to an improvement in ammonia among cirrhosis patients and this effect was bolded in multi-strain and long-term administration. However, this treatment was not more effective to exert favorable changes in term of liver enzymes, synthetic and excretory potential markers and creatinine level.