Evaluation of the efficacy of steroid therapy on acute liver failure

Abstract

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.

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 cumulative 60‐day and 1‐year survival rates were not significantly different between the steroid and control groups. We speculated that steroids might be beneficial for the patients with a less severe form of the disease . To test this hypothesis, patients were assigned to subgroups based on their ACLF grade and MELD score.…”

“…We speculated that steroids might be beneficial for the patients with a less severe form of the disease. 13,14 To test this hypothesis, patients were assigned to subgroups based on their ACLF grade and MELD score. A stratified analysis failed to prove that steroid treatment is beneficial for survival.…”

“…Previous studies have suggested that steroids may be more effective in patients with acute liver failure that was not thought to be too late to be conservatively treated. 13,14 We then tested this possibility in patients with ACLF. The patients were regrouped based on their ACLF grade or MELD score.…”

Indeterminate pediatric acute liver failure is uniquely characterized by a CD103+CD8+ T‐cell infiltrate

“…When considering steroid therapy for children with ALF, it is important to note that the majority of studies in adult patients with ALF have failed to show any survival benefit of steroid treatment . However, recent single‐center retrospective reports from China and Japan suggest that intravenous steroids may improve spontaneous survival in adult ALF . In the pediatric population, indeterminate ALF is more prevalent in young children, who may mount different innate and adaptive immune responses compared to adults or who may be susceptible to a type of immune‐mediated ALF not seen in adults and therefore may respond differently to immunosuppressive therapy.…”

Systematic review: non A‐E, seronegative or indeterminate hepatitis; what is this deadly disease?

“…Nevertheless, they did suggest improved rates of spontaneous survival associated with steroid use among patients who had significantly elevated alanine aminotransferase (ALT) greater than 30 x the upper limit of normal and coma grade <4 with MELD scores less than 35. This finding was most significant in those with an illness duration of less than 2 weeks . Unfortunately, they did not specify outcomes for different aetiologies and it is therefore hard to evaluate any specific benefit in indeterminate hepatitis.…”