Bilirubin response to corticosteroids in severe alcoholic hepatitis.
BACKGROUND
There is little consensus on the management of alcoholic hepatitis, particularly with regard to corticosteroid therapy. We aimed to identify those patients who respond to corticosteroid therapy for alcoholic hepatitis.


METHODS
We identified 37 patients with alcoholic hepatitis with a modified Maddrey's discriminant function of 32 or greater. We assessed their outcomes at 28 and 56 days treatment after admission relative to their response to corticosteroid treatment.


RESULTS
Corticosteroid treated patients experienced a change in the serum bilirubin concentration after 6-9 days of -23.0+/-4.7%. Overall, the mortality was 18.9 and 35.1% at 28 and 56 days. Response to corticosteroids was defined as a 25% fall in serum bilirubin after 6-9 days of treatment. The mortality of the non-responders was 36.8% and 57.9% at 28 and 56 days compared with 0% (P=0.0148) and 11.1% (P=0.0084) for corticosteroid responders.


CONCLUSIONS
Patients with a 25% fall in bilirubin after 6-9 days of corticosteroid therapy have a significant and sustained improvement in outcome.
Morris
Judith M
JM
Victoria Infirmary, Department of Gastroenterology, Glasgow, UK.
Forrest
Ewan H
EH
D000284:Administration, Oral; D000890:Anti-Infective Agents / Q000627:therapeutic use; D001663:Bilirubin / Q000097:blood*; D005938:Glucocorticoids / Q000008:administration & dosage*; D006519:Hepatitis, Alcoholic / Q000097:blood / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D008875:Middle Aged; D011239:Prednisolone / Q000008:administration & dosage*; D011446:Prospective Studies; D012189:Retrospective Studies; D018805:Sepsis / Q000150:complications / Q000188:drug therapy; D016896:Treatment Outcome
D000890:Anti-Infective Agents; D005938:Glucocorticoids; D011239:Prednisolone; D001663:Bilirubin