Dexamethasone in outcome of patients with hepatitis <scp>B</scp> virus‐related acute‐on‐chronic liver failure

Chen, Jun Feng; Wang, Ke Wei; Zhang, Shao Quan; Lei, Zi Ying; Xie, Jiemin; Zhu, Jianxi; Weng, Weizhen; Gao, Zhi; Li, Bing

doi:10.1111/jgh.12454

Cited by 21 publications

(16 citation statements)

References 14 publications

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“…Steroid pulse treatment in the first 2 to 3 days was more common in the Asian studies. Few studies have reported the efficacy of steroid treatment in patients with ACLF . The heterogeneity of these patients is part of the difficulty that underlies such studies.…”

Section: Discussionmentioning

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%

“…Few studies have reported the efficacy of steroid treatment in patients with ACLF. 16 The heterogeneity of these patients is part of the difficulty that underlies such studies. Furthermore, current definitions (including CLIF-C criteria) are still suboptimal for Asian patients with ACLF who are frequently precipitated by hepatitis B.…”

Section: Discussionmentioning

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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“…Glucocorticoids as immunomodulatory agents have been applied to treat allergic and chronic inflammatory diseases, such as asthma, dermatitis and rheumatoid arthritis since the 1950s (31,32). Several recent RCTs showed that a combination of glucocorticoids and conventional treatment was superior to conventional monotherapy (33)(34)(35)(36); however, other reports claimed that mono-therapies and combination therapy had similar results (37).…”

Section: Discussionmentioning

confidence: 99%

The Efficacy and Safety of Glucocorticoids Plus Conventional Therapy for Hepatitis B-Related Liver Failure in China: A Meta-Analysis

et al. 2019

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The aim of this meta-analysis was to evaluate the efficacy and safety of glucocorticoid plus conventional therapy in hepatitis B-related liver failure. Evidence Acquisition: A systematic search was performed in PubMed, Embase, the Cochrane library, China National Knowledge Infrastructure, Wanfang database, and Google Scholar. The primary outcome was improvement in the mortality rate and the secondary outcome was the incidence of complications. Pooled data were based on the fixed-effect model. Results: Ten studies with 891 patients were included in the meta-analysis. Glucocorticoid plus conventional therapy (OR = 3.98, 95%

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“…In patients with septic shock, hydrocortisone treatment for 72 h reduced pro inflammatory responses (e.g., IL-6), neutrophil activation and improved monocyte phagocytosis capacity [66]. In Hepatitis B virus (HBV)-associated ACLF, GC treatment was associated with restoration of myeloid dendritic cells and survival in one study [67]; another showed no benefit on survival [68].…”

Section: Gut Microbiotamentioning

confidence: 99%

Immunotherapy in the treatment and prevention of infection in acute-on-chronic liver failure

et al. 2015

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Chronic liver disease, depicted by gradual destruction and fibrosis of the liver, is a condition with high and probably increasing prevalence worldwide. Its deterioration, acute-on-chronic liver failure (ACLF), is characterized by an in-hospital mortality of up to 65%. Infectious complications are the main precipitants eliciting ACLF and concurrently the main cause of death from ACLF. Patients have a marked susceptibility to bacterial infections, which is thought to arise a consequence of an inadequate immune response to microbial challenge, termed immuneparesis. The pathophysiologic mechanisms remain poorly understood. Treatments aimed at restoring the patients' immune function may prevent onset of ACLF and death from secondary infections. A number of drugs approved for patients with liver disease bear immunomodulatory potential such as albumin, glucocorticoids, N-acetylcysteine. Specific targets have been defined that may lead to development of new immunotherapeutic agents. Here, we summarize the pathophysiology of immuneparesis in ACLF and drug candidates to restore immune function and improve survival in the future.

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Dexamethasone in outcome of patients with hepatitis B virus‐related acute‐on‐chronic liver failure

Abstract: Dexamethasone cannot improve liver functions and 12-week survival rates of patients with HBV-related ACLF. Age, MELD score, and encephalopathy are independent risk factors.

Cited by 21 publications

References 14 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

The Efficacy and Safety of Glucocorticoids Plus Conventional Therapy for Hepatitis B-Related Liver Failure in China: A Meta-Analysis

Immunotherapy in the treatment and prevention of infection in acute-on-chronic liver failure

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