title: 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.
abstract: 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.
authors.affiliation: Hôpital Antoine Béclère, Clamart, France
authors.forename: Philippe
authors.initials: P
authors.lastname: Mathurin
authors.forename: Charles L
authors.initials: CL
authors.lastname: Mendenhall
authors.forename: Robert L
authors.initials: RL
authors.lastname: Carithers
authors.forename: Marie-Jose
authors.initials: MJ
authors.lastname: Ramond
authors.forename: Willis C
authors.initials: WC
authors.lastname: Maddrey
authors.forename: Peter
authors.initials: P
authors.lastname: Garstide
authors.forename: Bernard
authors.initials: B
authors.lastname: Rueff
authors.forename: Sylvie
authors.initials: S
authors.lastname: Naveau
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Chaput
authors.forename: Thierry
authors.initials: T
authors.lastname: Poynard
mesh_terms: 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
chemical_list: D000305:Adrenal Cortex Hormones; D001663:Bilirubin