Beneficial effect of corticosteroids for patients with severe drug‐induced liver injury

Hu, Ping; Wang, Pei Qin; Han, Chunming; Hu, Xiao Fan; Xie, Qiu; Shi, Jian; Lin, Lin; Xie, Wei

doi:10.1111/1751-2980.12383

Cited by 36 publications

(47 citation statements)

References 30 publications

(52 reference statements)

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“…15 As a potent anti-inflammatory agent, glucocorticosteroids used for the treatment of ALF have been investigated with various outcomes. Studies in Asian populations commonly reported a more favorable outcome than those conducted in Western populations, [6][7][8] possibly due to the differences in ethnicity, background liver disease and precipitating events. Nevertheless, the inclusion criteria and treatment strategies also varied widely.…”

Section: Discussionmentioning

confidence: 99%

“…The hallmark of ACLF is intensive systemic inflammation like sepsis . Corticosteroids are known to suppress the inflammatory process and have been demonstrated to reduce mortality in patients with acute liver failure (ALF) but not in others . The variation might be attributed to the differences in inclusion criteria, precipitating events, ethnic background and life‐supporting strategies among different studies.…”

Section: Introductionmentioning

confidence: 99%

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Steroid treatment in patients with acute‐on‐chronic liver failure precipitated by hepatitis B: A 10‐year cohort study in a university hospital in East China

Huang

Zheng

et al. 2019

J of Digest Diseases

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Objective To investigate retrospectively the efficacy of steroids in patients with acute‐on‐chronic liver failure (ACLF) precipitated by hepatitis B. Methods Patients with ACLF precipitated by hepatitis B were included and categorized according to treatment modalities (steroid vs. control). Survival and clinical characteristics, including patients’ age, baseline ACLF grade, the model for end‐stage liver disease (MELD) score, and occurrence of infection were compared between the two groups. Survival analyses of subgroups classified by their age, ACLF grade and MELD score were performed. Cox regression analyses were conducted to identify factors associated with 60‐day cumulative and transplant‐free mortality. Results From 2007 to 2016, 293 patients with hepatitis B‐precipitated ACLF were recruited, among whom 162 received at least five consecutive doses of corticosteroids. By day 60 transplant‐free survival was 62.6% in the control group compared with 53.7% in the steroid group (P = 0.126). Steroid treatment failed to show a survival benefit in the survival analysis among the subgroup. Within 60 days, pulmonary and overall infections occurred with higher frequency in the steroid‐treated group than in the controls (P = 0.003 and < 0.001, respectively). In the univariate analysis, age, baseline MELD score >20, CLIF consortium (CLIF‐C) ACLF grade 2‐3, pulmonary infection and overall infection were associated with 60‐day mortality. In the multivariate analysis, older age, baseline MELD score >20 and CLIF‐C ACLF grade 2‐3 were independent risk factors of 60‐day mortality. Conclusion Steroid treatment did not improve transplant‐free survival in patients with ACLF precipitated by hepatitis B.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Steroid treatment in patients with acute‐on‐chronic liver failure precipitated by hepatitis B: A 10‐year cohort study in a university hospital in East China

Huang

Zheng

et al. 2019

J of Digest Diseases

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“…Available data also suggested that corticosteroids are invalid for DILI patients with ALF. We re‐analyzed data from the drug‐induced ALF cases in our study and also found that corticosteroid administration did not alter the prognosis for those patients with ALF . Consequently, the most appropriate candidates for corticosteroid treatment might be the patients with severe DILI who are prone to develop ALF.…”

Section: Dili Candidates Who May Benefit From Corticosteroid Therapymentioning

confidence: 82%

“…On the contrary, several investigations did show the beneficial effect of corticosteroids in DILI patients . Hou et al retrospectively collected data from 70 DILI patients with hepatocellular injury type and TB ≥10 × the upper limit of normal (ULN), of whom 20 received corticosteroid step‐down therapy.…”

Section: Efficacy Of Corticosteroid Treatment In Dili: Pros and Consmentioning

confidence: 99%

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Corticosteroid therapy in drug‐induced liver injury: Pros and cons

Xie

2019

J of Digest Diseases

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Drug‐induced liver injury (DILI) is a liver toxicity induced by a drug or its metabolite. The incidence of DILI continues to increase and it has been an enormous challenge worldwide, while the prognosis is not optimistic. Currently, the most effective treatment for DILI is to suspend the offending drug(s) and to avoid re‐exposure, with no definitive therapy available for idiosyncratic DILI with or without acute liver failure. Given the anti‐inflammatory effects of corticosteroids, they have been widely used in DILI in clinical practice, although their efficacy remains controversial. Several studies have shown their beneficial effects but a few reports have refuted the efficacy of corticosteroids in treating patients with DILI. In this review, we summarized the history and current status of corticosteroid use in liver diseases and the pros and cons of corticosteroid treatment in DILI, and we explored the DILI candidates who may benefit from corticosteroid therapy, the administration route and dosage, and the adverse effects related to corticosteroid use.

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The Impact of Biologics for the Management of Inflammatory Bowel Disease on Liver Enzymes

Aby

Lake

Vaughn

2020

Clinical Liver Disease

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Beneficial effect of corticosteroids for patients with severe drug‐induced liver injury

Abstract: Corticosteroids are not detrimental to DILI, but instead ameliorate liver injury and improve patient survival. Short-time use of corticosteroids is strongly recommended for severe DILI patients with hyperbilirubinemia.

Cited by 36 publications

References 30 publications

Steroid treatment in patients with acute‐on‐chronic liver failure precipitated by hepatitis B: A 10‐year cohort study in a university hospital in East China

Steroid treatment in patients with acute‐on‐chronic liver failure precipitated by hepatitis B: A 10‐year cohort study in a university hospital in East China

Corticosteroid therapy in drug‐induced liver injury: Pros and cons

The Impact of Biologics for the Management of Inflammatory Bowel Disease on Liver Enzymes

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