Dexamethasone in outcome of patients with hepatitis B virus-related acute-on-chronic liver failure.
OBJECTIVE
Acute-on-chronic liver failure (ACLF) caused by hepatitis B virus (HBV) is a severe disease with high mortality. Immune injury plays an important role during the early stage of the disease. Our research aimed to investigate the safety and efficacy of dexamethasone therapy for patients with HBV-related ACLF.


METHODS
A total of 134 inpatients with HBV-induced ACLF were enrolled from January 2009 to December 2012. All the patients received the standard medicine treatment (SMT), among whom 31 cases underwent additional dexamethasone injection for three times (dexamethasone treatment [DMT] Group). A total of 35 patients (SMT Group) matched for baseline characters served as controls. Both the groups were followed up for 12 weeks. The survival rates, liver functions, and complications were recorded.


RESULTS
The 12-week cumulative survival rates were 45.7% (16/35)and 48.4% (15/31) for SMT Group and DMT Group, respectively, and no significant differences were found (P = 0.959). There were no dramatic differences in liver function and model for end-stage liver disease (MELD) score at 1, 2, 4, 8, and 12 weeks between two groups. There were no significant differences in the incidence of complications (i.e. infection, gastrointestinal bleeding, encephalopathy, hepatorenal syndrome, and ascites) from 1 to 12 weeks between Group SMT and Group DMT. More than 40 ages, MELD score more than 28 and encephalopathy were independent risk factors for the mortality of patients.


CONCLUSIONS
Dexamethasone cannot improve liver functions and 12-week survival rates of patients with HBV-related ACLF. Age, MELD score, and encephalopathy are independent risk factors.
Department of Infectious Diseases, Third Affiliated Hospital of Sun Yet-Sen University, Guangzhou, Guangdong Province, China; Key Laboratory of Tropical Disease Control, Sun Yat-Sen University, Ministry of Education, Guangzhou, Guangdong Province, China.
Jun-Feng
JF
Chen
Ke-Wei
KW
Wang
Shao-Quan
SQ
Zhang
Zi-Ying
ZY
Lei
Jun-Qiang
JQ
Xie
Jian-Yun
JY
Zhu
Wei-Zhen
WZ
Weng
Zhi-Liang
ZL
Gao
Bing-Liang
BL
Lin
D000328:Adult; D000367:Age Factors; D001927:Brain Diseases; D003907:Dexamethasone / Q000008:administration & dosage / Q000627:therapeutic use*; D058625:End Stage Liver Disease / Q000188:drug therapy* / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006509:Hepatitis B / Q000150:complications*; D006801:Humans; D017114:Liver Failure, Acute / Q000188:drug therapy* / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
D005938:Glucocorticoids; D003907:Dexamethasone
acute liver failure; acute-on-chronic; clinical; dexamethasone; hepatitis B; outcome