The Efficacy and Safety of Sodium-Glucose Cotransporter Protein 2 Inhibitors (SGLT2Is) in Liver Cirrhosis: A Systematic Review and Meta-Analysis

BackgroundSodium-Glucose Cotransporter Protein 2 Inhibitors (SGLT2Is) are known for their cardiovascular and renoprotective benefits and are efficacious in managing Metabolic-Associated Steatotic Liver Disease (MASLD). However, limited data exist on their use in advanced liver disease, particularly liver cirrhosis. AimsTo synthesize existing evidence on the efficacy and safety of SGLT2Is in patients with liver cirrhosis and to provide clinical guidance. MethodsA systematic review and meta-analysis were conducted following the PRISMA 2020 Statement. Searches in major health databases identified studies where SGLT2Is were used in patients with cirrhosis. The analysis focused on prospective trials in decompensated cirrhosis and retrospective studies in compensated cirrhosis. Primary outcomes included the need for large-volume paracentesis (LVP) and mortality. Secondary outcomes assessed weight loss, loop diuretic dose reduction, residual ascites, acute kidney injury (AKI), hyponatremia, hepatic encephalopathy (HE), and urinary tract infections (UTIs). ResultsTen studies (8 peer-reviewed) from 2020-2024 were included: 2 randomized controlled trials, 4 single-arm prospective trials, and 4 retrospective studies. SGLT2I use was associated with reduced LVP (RR 0.45, CI 0.31-0.66, p<0.001) and mortality (aHR 0.46, CI 0.38-0.55, p<0.001). Benefits included a 39 mg reduction in loop diuretic dose, 7 kg weight loss, and no significant increase in residual ascites, AKI, hyponatremia, HE, or UTIs. ConclusionsSGLT2Is show promise in managing diuretic-resistant ascites and reducing mortality in liver cirrhosis without causing significant adverse events. Larger, randomized controlled trials are needed to validate these findings.