Efficacy of high‐dose corticosteroid in the early stage of viral acute liver failure

Fujiwara, Keiichi; Yasui, Shin; Yonemitsu, Yutaka; Mikata, Rintaro; Arai, Makoto; Kanda, Tatsuo; Imazeki, Fumio; Oda, Shigeto; Yokosuka, Osamu

doi:10.1111/hepr.12148

Cited by 50 publications

(64 citation statements)

References 24 publications

(43 reference statements)

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“…The current study also reported that the SS rate was 64% in patients with MELD scores <35 and HE grades <4; however, the SS rate was only at 20% in patients with MELD scores ≥35 or HE grade 4, amongst 35 patients with early introduction of corticosteroids (time interval, ≤2 weeks). These results indicated that early intervention with steroids was effective in improving the prognosis of patients with less severe liver failure; these findings were similar to the results reported by Fujiwara et al (21). Therefore, corticosteroids should be introduced as early as possible for patients with less severe liver failure.…”

Section: Discussionsupporting

confidence: 89%

“…When extensive confluent cellular necrosis develops, the administration of corticosteroids is not able to improve the prognosis of patients with ALF and SALF. This is as corticosteroids have a limited effect on the regenerative ability of hepatocytes over a short time period (21). Therefore, the selection of appropriate patients and the timing of intervention with corticosteroids are very important factors in the prognosis of patients with ALF and SALF.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of the efficacy of steroid therapy on acute liver failure

Zhao

Zhang

Xie

et al. 2016

Experimental and Therapeutic Medicine

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Abstract. The effects of corticosteroids in the treatment of patients with acute or subacute liver failure (ALF or SALF) are controversial. The aims of the present study were to evaluate the efficacy of corticosteroids in improving spontaneous survival (SS) rate in patients with ALF and SALF, and to determine the groups with the highest rates of response to, and the most effective timing of, corticosteroid administration. A retrospective analysis was performed of all patients with ALF and SALF who were hospitalized in the Department of Infectious Diseases, Southwest Hospital, Chongqing, China from 2000-2012. The most common result of this was SS. A total of 238 patients were studied, including 73 patients with ALF (n=34 steroids, n=39 no steroids) and 165 patients with SALF (n=21 steroids, n=144 no steroids). Corticosteroids improved rates of SS in patients with liver failure (steroids vs. no steroids, 38.2 vs. 20.2%; P= 0.011), including patients with ALF (steroids vs. no steroids, 29.4 vs. 5.1%; P=0.013) and with SALF (steroids vs. no steroids, 52.4 vs. 24.3%; P=0.013), patients with viruses (steroids vs. no steroids, 32.4 vs. 14.1%; P=0.042) and patients without viruses (steroids vs. no steroids, 50.0 vs. 24.1%; P=0.043). SS rates were extremely low for patients with coma grade 4 or Model for End-stage Liver Disease (MELD) scores ≥35 (2.2 vs. 11.8%; P=0.180). A significantly improved rate of SS associated with steroid use was observed among patients who had alanine aminotransferase (ALT) levels ≥30 x the upper limit of normal and coma grade <4 and MELD scores <35 (65.0 vs. 17.4%; P= 0.002). SS associated with steroid use was significantly higher in patients with an illness duration ≤2 weeks compared with patients with an illness duration >2 weeks (51.4 vs. 15.0%; P=0.010). Corticosteroids improved the prognosis of patients with ALF and SALF. The highest rates of response were observed in patients with a lower MELD score and coma grade but who had extremely high ALT levels. The most effective treatment time was within 2 weeks of the onset of symptoms.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Evaluation of the efficacy of steroid therapy on acute liver failure

Zhao

Zhang

Xie

et al. 2016

Experimental and Therapeutic Medicine

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“…A number of studies have shown that the immune-inflammatory cytokines in the prophase or early phase of HBV-ACLF corresponds to a high-expression status, suggesting that cytokines play an important factor in the development of HBV-ACLF (9, 10, 15). In this context, we used the CBA method to detect the changes in the various cytokine levels in vivo prior to and at the time of the diagnosis of HBV-ACLF.…”

Section: Discussionmentioning

confidence: 99%

“…Currently, glucocorticoids are mainly used for acute exacerbation of CHB, but their specific duration and dose remain unclear (11, 15). Some experts have proposed that they may be applied to the early stage of HBV-ACLF (10); however, Karkhanis et al reported that corticosteroids did not improve overall survival or spontaneous survival in drug-induced, indeterminate or autoimmune acute liver failure (25). Like corticosteroids, IL-10 is a negative regulator of inflammation and could therefore be considered as a possible therapeutic tool.…”

Section: Discussionmentioning

confidence: 99%

“…Our preliminary studies suggested that there were high immune activities in vivo at the early stage of HBV-ACLF (9). Fujiwara et al’s reports also showed that the use of corticosteroid therapy in the early phase of HBV-related liver failure could partly improve liver regeneration and reduce mortality rate; however, its efficacy remains limited (10, 11). These studies also indicated the presence of a high immune state in the early phase of HBV-ACLF.…”

Section: Introductionmentioning

confidence: 99%

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Plasma Interleukin-10: A Likely Predictive Marker for Hepatitis B Virus-Related Acute-on-Chronic Liver Failure

Wang

et al. 2014

Hepat Mon

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Background:The pathogenesis of HBV-related acute-on-chronic liver failure (HBV-ACLF) is mainly based on a heightened immune-inflammatory reaction; however, the intimate underlying mechanism remains unclear.Objectives:The aim of the study was to explore potential key immune molecular targets that could serve as early predictive markers for HBV-ACLF.Patients and Methods:Twenty-seven patients with acute exacerbation of chronic hepatitis B (CHB) (defined by: alanine transaminase ≥ 20 ULN, total bilirubin ≥ 5 ULN, 40% < prothrombin time activity ≤ 60%) and without cirrhosis were divided into 18 cases which did not progress to HBV-ACLF (defined by: prothrombin time activity < 40% and development within four weeks of hepatic encephalopathy and/or ascites) and nine cases that developed HBV-ACLF. Nine healthy people defined the normal control group (NC). Interleukin-1β (IL-1β), IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p70, TNF-α and IFN-γ protein levels were assayed by Cytometric Bead Array (CBA) in blood plasma. The ELISA method was applied to confirm IL-10 detection using the CBA method.Results:IL-4, IL-12p70 and IFN-γ were undetectable; IL-1β, IL-6, IL-8, IL-10 and TNF-α levels were significantly higher than in NC. Moreover, cytokines reached the highest levels in acute exacerbation of CHB, with the exception of IL-2 and IL-8. When comparing the HBV-ACLF patients prior to and at the time of ACLF diagnosis, IL-10 was the only cytokine that exhibited a significant decrease (P = 0.008). IL-10 concentrations were positively correlated to ALT levels (r = 0.711, P < 0.001).Conclusions:The assessment of plasma IL-10 levels in chronic hepatitis B acute exacerbation may provide an early predictive marker for progression to HBV-ACLF.

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