Corticosteroids improve short-term survival in patients with severe alcoholic hepatitis (AH): individual data analysis of the last three randomized placebo controlled double blind trials of corticosteroids in severe AH.
OBJECTIVE
Controversy surrounding the efficacy of corticosteroids in severe alcoholic hepatitis (AH) persists.


OBJECTIVE
(a) to analyze individual data of patients with severe AH discriminant function (DF)> or =32 from the last three randomized controlled trials; and (b) to identify the independent prognostic factors associated with short-term survival.


METHODS
Individual data were collected from the three principal investigators. Survival analysis was performed at 28 days using the Kaplan-Meier method and log-rank test. The independent prognostic values were assessed by the proportional hazards regression model.


RESULTS
About 102 placebo and 113 corticosteroid patients with DF > or =32 were analyzed. At 28 days, corticosteroid patients had significantly higher survival: 84.6+/-3.4% vs. 65.1+/-4.8%, P=0.001. In univariate analysis, corticosteroid treatment, age, DF, albumin, creatinine and encephalopathy were prognostic factors. In multivariate analysis, age (P=0.0001), serum creatinine (P<0.002) and corticosteroid treatment (P=0.002) were independent prognostic variables. A more dramatic decrease of median serum bilirubin values (micromol/l) was observed at 7 and 14 days in corticosteroid patients (P<0.05) : -76.5 vs. -35 and -105 vs. -45.


CONCLUSIONS
Corticosteroids improved short-term survival of patients with severe AH. Age and serum creatinine are independent prognostic factors. Corticosteroids are recommended for patients with severe AH.
Mathurin
Philippe
P
Hôpital Antoine Béclère, Clamart, France
Mendenhall
Charles L
CL
Carithers
Robert L
RL
Ramond
Marie-Jose
MJ
Maddrey
Willis C
WC
Garstide
Peter
P
Rueff
Bernard
B
Naveau
Sylvie
S
Chaput
Jean-Claude
JC
Poynard
Thierry
T
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D001663:Bilirubin / Q000097:blood; D004311:Double-Blind Method; D006501:Hepatic Encephalopathy / Q000188:drug therapy; D006519:Hepatitis, Alcoholic / Q000188:drug therapy* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D011517:Prothrombin Time; D016032:Randomized Controlled Trials as Topic; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016019:Survival Analysis
D000305:Adrenal Cortex Hormones; D001663:Bilirubin