Survival and prognostic factors in patients with severe alcoholic hepatitis treated with prednisolone.
OBJECTIVE
Corticosteroids have been shown to significantly decrease short-term mortality in patients with severe alcoholic hepatitis. However, independent factors associated with a favorable outcome and long-term survival are unknown. The aim of this study was to examine prognostic factors and long-term survival in patients with biopsy-proven severe alcoholic hepatitis.


METHODS
Of 183 patients studied, 61 had been randomized in a previous trial; 32 of them were treated with prednisolone (group I) and 29 were not treated (group II); 61 were treated from the end of this randomized trial (group III); and 61 were simulated (group IV).


RESULTS
At 1 year, survival in group I (69%; confidence interval [CI], 57%-81%) and group III (71%; CI, 55%-87%) was better than in the nontreated groups (group II, 41%; CI, 23%-59%; P = 0.01) (group IV, 50%; CI, 37%-63%; P = 0.05). At 2 years, survival was not significantly different. Treated patients with marked liver polymorphonuclear infiltrate had better 1-year survival (76%; CI, 64%-88%) than the others (53%; CI, 35%-71%; P = 0.05). Treated patients with polymorphonuclear counts of > 5500/mm3 had better 1-year survival (77%; CI, 65%-89%) than the others (40%; CI, 14%-66%; P = 0.003). In the 93 treated patients, liver polymorphonuclear infiltrate (P < 0.03) and polymorphonuclear count (P < 0.001) were independently correlated with 1-year survival.


CONCLUSIONS
Prednisolone reduced mortality by at least 1 year. Liver polymorphonuclear infiltrate and polymorphonuclear count were independent prognostic factors.
Mathurin
P
P
Service des Traitements Ambulatoires des Maladies Alcooliques, Hôpital Beaujon, Clichy, France.
Duchatelle
V
V
Ramond
M J
MJ
Degott
C
C
Bedossa
P
P
Erlinger
S
S
Benhamou
J P
JP
Chaput
J C
JC
Rueff
B
B
Poynard
T
T
D005260:Female; D006519:Hepatitis, Alcoholic / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D007958:Leukocyte Count; D008099:Liver / Q000473:pathology; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D015999:Multivariate Analysis; D009504:Neutrophils / Q000473:pathology; D011239:Prednisolone / Q000627:therapeutic use*; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
D011239:Prednisolone