title: Glucocorticoids can increase the survival rate of patients with severe viral hepatitis B: a meta-analysis.
abstract: OBJECTIVE
  Severe viral hepatitis B is a disease associated with significant morbidity and mortality. Clinical controlled trials show that the efficacy of treatment of severe viral hepatitis B with glucocorticoids remains debatable. Therefore, we carried out this meta-analysis to evaluate the safety, efficacy, and side effects of glucocorticoid therapy for severe viral hepatitis B.
  
  
  METHODS
  We searched PubMed, Medline, Embase, Cochrane Library, and Google Scholar for randomized-controlled trials published before April 2012 in which glucocorticoid therapy was compared with routine treatment for severe viral hepatitis B. The primary outcome was the survival rate of the two groups.
  
  
  RESULTS
  We selected eight controlled clinical trials, which included 597 patients. We recorded a benefit of glucocorticoid treatment on the survival rate of patients with severe viral hepatitis B (597 patients) [risk ratio (RR)=1.188, 95% confidence interval (CI) 1.030-1.369, P=0.018]. The benefit was most noticeable in patients at the stage of preliver failure (409 patients) (RR=1.275, 95% CI 1.077-1.510, P=0.005), whereas there was no efficacy for patients with liver failure (188 patients) (RR=1.008, 95% CI 0.774-1.312, P=0.955). Glucocorticoid treatment was not associated with the development of secondary infection and bleeding.
  
  
  CONCLUSIONS
  Treatment with glucocorticoids can significantly increase the survival rate of patients with severe hepatitis B. The benefit was most noticeable in patients at the stage of preliver failure. However, the incidence of secondary infection and bleeding did not change significantly. This finding suggests that prompt and timely glucocorticoid treatment is crucial.
authors.affiliation: Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Chongqing, People's Republic of China.
authors.forename: Bing
authors.initials: B
authors.lastname: He
authors.forename: Yao
authors.initials: Y
authors.lastname: Zhang
authors.forename: Mu-Han
authors.initials: MH
authors.lastname: Lü
authors.forename: Ya-Ling
authors.initials: YL
authors.lastname: Cao
authors.forename: Ya-Han
authors.initials: YH
authors.lastname: Fan
authors.forename: Jia-Qi
authors.initials: JQ
authors.lastname: Deng
authors.forename: Shi-Ming
authors.initials: SM
authors.lastname: Yang
mesh_terms: D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D005938:Glucocorticoids / Q000009:adverse effects / Q000627:therapeutic use*; D006509:Hepatitis B / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality; D006801:Humans; D016017:Odds Ratio; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D005938:Glucocorticoids