Steroid use in acute liver failure

Karkhanis, Jamuna; Verna, Elizabeth C.; Chang, Matthew S.; Stravitz, R. Todd; Schilsky, Michael L.; Lee, William M.; Brown, Robert S.

doi:10.1002/hep.26678

Cited by 167 publications

(140 citation statements)

References 22 publications

Supporting

Mentioning

132

Contrasting

Unclassified

Order By: Relevance

“…55,56 A more recent study from the ALFSG corroborated this, showing no improvement in overall survival in drug-induced, indeterminate or autoimmune ALF (61% versus 66%, p=0.41). 57 In fact, lower survival was observed in those patients with the highest model for end stage liver disease scores (>40) after corticosteroid therapy (30% versus 57%, p=0.03). NAC has a well-established role in paracetamol-induced ALF 44 although it is now also recommended in selected cases of non-paracetamol ALF.…”

Section: Acute Liver Failurementioning

confidence: 90%

Drug-induced liver injury

2016

View full text Add to dashboard Cite

Drug-induced liver injury (DILI) remains the most common cause of acute liver failure (ALF) in the western world. Excluding paracetamol overdose, nearly all DILI encountered in the clinical setting is idiosyncratic in nature because affected individuals represent only a small proportion of those treated with such drugs. In many cases, the mechanism for idiosyncrasy is immune-mediation and is often identifi ed by genetic risk determined by human leukocyte antigen variants. In the absence of diagnostic tests and/or biomarkers, the diagnosis of DILI requires a high index of suspicion after diligently excluding other causes of abnormal liver tests. Antibiotics are the class of drugs most frequently associated with idiosyncratic DILI, although recent studies indicate that herbal and dietary supplements are an increasingly recognised cause. It is imperative that upon development of DILI the culprit drug be discontinued, especially in the presence of elevated transaminases (aspartate aminotransferase/alanine aminotransferase ratio ≥5 times the upper limit of normal) and/or jaundice. Risk factors for the development ALF include hepatocellular DILI and female gender, the treatment being supportive with some benefi t of N-acetylcysteine in the early stages. In view of the poor transplant-free survival in idiosyncratic DILI, early consideration for liver transplant is mandatory. KEYWORDS : Autoimmune hepatitis , cholestasis , drug-induced acute liver failure , herbal and dietary supplements , hepatocellular DILI , hepatotoxicity IntroductionAt a regulatory level, drug-induced liver injury (DILI) is the commonest reason for withdrawing drugs from the market and/or issuing warnings and modification of use.1 DILI is classified as either predictable or unpredictable (idiosyncratic). 2The former tends to be dose-related, has a short latency (days), is due to direct toxicity of the drug or its metabolite, and is ABSTRACT Drug-induced liver injuryreproducible in animal models (eg paracetamol overdose). 3The vast majority of DILI, however, is idiosyncratic or unpredictable -it is unexpected based on the pharmacological actions of the drug and in most cases routine animal toxicology fails to identify the risk of subsequent clinical toxicity. 4 This review shall largely focus on idiosyncratic DILI .

show abstract

Section: Acute Liver Failurementioning

confidence: 90%

Drug-induced liver injury

2016

View full text Add to dashboard Cite

show abstract

“…use was also identified to be an independent predictor of an improved SS rate. These findings indicated that intervention with corticosteroids was effective in preventing the disease progression and improving the prognosis of ALF and SALF, which was inconsistent with the results reported by Karkhanis et al (20). The discrepancy in the results in these two studies may be due to the different criteria used to define SS.…”

Section: Discussionmentioning

confidence: 59%

“…The discrepancy in the results in these two studies may be due to the different criteria used to define SS. In the present study, SS was defined as survival without transplantation until 24 weeks, whereas the Karkhanis et al (20) study defined SS as survival without transplantation for only 21 days. It is important to note that many patients surviving to 3 weeks may succumb to liver failure after 4-24 weeks.…”

Section: Discussionmentioning

confidence: 85%

“…However, the administration of corticosteroids in patients with ALF and SALF remains controversial. A recent report by Karkhanis et al (20) revealed that corticosteroids were not effective in improving the prognosis of patients with ALF. These extent of hepatic necrosis and the regenerative ability of hepatocytes are important in determining the prognosis of liver failure (3).…”

Section: Introductionmentioning

confidence: 98%

See 1 more Smart Citation

Evaluation of the efficacy of steroid therapy on acute liver failure

Zhao

Zhang

Xie

et al. 2016

Experimental and Therapeutic Medicine

View full text Add to dashboard Cite

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.

show abstract

“…However, this increases sepsis risk and may preclude definitive LT. One study suggested that in cases of ALF due to immune-mediated pathologies, corticosteroids did not improve survival. 12 The majority of these patients are…”

Section: Specific Therapiesmentioning

confidence: 99%

Acute liver failure

Blackmore

Bernal

2015

Clinical Medicine

View full text Add to dashboard Cite

Acute liver failure (ALF) is a rare critical illness with high mortality whose successful management requires early recognition and effective initial management. Though it may result from a wide variety of causes, in the UK and much of the developed world most cases result from paracetamolinduced hepatotoxicity, and administration of antidotal N-acetyl cysteine at first recognition is key. Involvement of local critical care services should occur at an early stage for stabilisation, monitoring and supportive care with parallel discussion with specialist liver centres to identify those patients who may benefit from transfer. Prognostic criteria are applied to identify patients for emergency liver transplantation, and candidates for surgery are prioritised on waitlisting schemes. Outcomes now approach that of elective surgery. However, the majority of cases, and particularly those with paracetamolinduced disease, recover with supportive medical care alone. Overall outcomes for patients with ALF have improved dramatically over the last three decades, but mortality remains unacceptable and further advances in care are required.

show abstract

Steroid use in acute liver failure

Cited by 167 publications

References 22 publications

Drug-induced liver injury

Drug-induced liver injury

Evaluation of the efficacy of steroid therapy on acute liver failure

Acute liver failure

Contact Info

Product

Resources

About