Corticosteroids Improve Short-Term Survival in Patients With Severe Alcoholic Hepatitis (AH): Individual Data Analysis of the Last Three Randomized Placebo Controlled Double Blind Trials of Corticosteroids in Severe AH

J Hepatol. 2002 Apr;36(4):480-7. doi: 10.1016/s0168-8278(01)00289-6.

Abstract

Background/aims: Controversy surrounding the efficacy of corticosteroids in severe alcoholic hepatitis (AH) persists.

The aims of our study were: (a) to analyze individual data of patients with severe AH discriminant function (DF)> or =32 from the last three randomized controlled trials; and (b) to identify the independent prognostic factors associated with short-term survival.

Methods: Individual data were collected from the three principal investigators. Survival analysis was performed at 28 days using the Kaplan-Meier method and log-rank test. The independent prognostic values were assessed by the proportional hazards regression model.

Results: About 102 placebo and 113 corticosteroid patients with DF > or =32 were analyzed. At 28 days, corticosteroid patients had significantly higher survival: 84.6+/-3.4% vs. 65.1+/-4.8%, P=0.001. In univariate analysis, corticosteroid treatment, age, DF, albumin, creatinine and encephalopathy were prognostic factors. In multivariate analysis, age (P=0.0001), serum creatinine (P<0.002) and corticosteroid treatment (P=0.002) were independent prognostic variables. A more dramatic decrease of median serum bilirubin values (micromol/l) was observed at 7 and 14 days in corticosteroid patients (P<0.05) : -76.5 vs. -35 and -105 vs. -45.

Conclusions: Corticosteroids improved short-term survival of patients with severe AH. Age and serum creatinine are independent prognostic factors. Corticosteroids are recommended for patients with severe AH.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use*
  • Adult
  • Aged
  • Bilirubin / blood
  • Double-Blind Method
  • Hepatic Encephalopathy / drug therapy
  • Hepatitis, Alcoholic / drug therapy*
  • Hepatitis, Alcoholic / physiopathology*
  • Humans
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Prognosis
  • Prothrombin Time
  • Randomized Controlled Trials as Topic
  • Sensitivity and Specificity
  • Severity of Illness Index
  • Survival Analysis

Substances

  • Adrenal Cortex Hormones
  • Bilirubin