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

Abstract

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.

Acute-on-Chronic Liver Failure in Pregnant Patients with Chronic Hepatitis B: A Retrospective Observational Case Series Study

“…A retrospective study from China reported that steroids have no value in improving nontransplant survival in patients with HBV-ACLF. However, pulmonary and opportunistic infections occurred with a higher frequency (P = 0:003 and P < 0:001, respectively) in the steroid-treated group [10]. Therefore, the necessity of steroid treatment should be adequately assessed.…”

The Effect of Modified Sini Decoction on Survival Rates of Patients with Hepatitis B Virus Related Acute-on-Chronic Liver Failure

“…China has always maintained a high morbidity of chronic HBV infection. And in China, approximately 90% of ACLF is induced by chronic HBV infection [23]. HBV-ACLF is a devastating syndrome with extremely high mortality [24].…”

The Management of Glucocorticoid Therapy in Liver Failure

“…A recent study reported that early combination therapy with corticosteroid and NAs induces rapid resolution of inflammation in ALF due to transient HBV infection (24). It has been shown that with sufficient doses of NAs, GCs cannot affect the replication of HBV (12). However, Huang et al (12) investigated retrospectively the efficacy of GCs in patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF).…”

“…It has been shown that with sufficient doses of NAs, GCs cannot affect the replication of HBV (12). However, Huang et al (12) investigated retrospectively the efficacy of GCs in patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). It was indicated that GC treatment did not improve transplant-free survival in patients with HBV-ACLF.…”

“…The first paper on GCs therapy for liver failure was published in the 1960s. Nowadays, many basic and clinical studies have explored the feasibility of GCs treatment in liver failure (6–12), but they remain inconclusive for the application of GCs treatment in liver failure.…”