title: Evaluation of the efficacy of steroid therapy on acute liver failure.
abstract: The effects of corticosteroids in the treatment of patients with acute or subacute liver failure (ALF or SALF) are controversial. The aims of the present study were to evaluate the efficacy of corticosteroids in improving spontaneous survival (SS) rate in patients with ALF and SALF, and to determine the groups with the highest rates of response to, and the most effective timing of, corticosteroid administration. A retrospective analysis was performed of all patients with ALF and SALF who were hospitalized in the Department of Infectious Diseases, Southwest Hospital, Chongqing, China from 2000-2012. The most common result of this was SS. A total of 238 patients were studied, including 73 patients with ALF (n=34 steroids, n=39 no steroids) and 165 patients with SALF (n=21 steroids, n=144 no steroids). Corticosteroids improved rates of SS in patients with liver failure (steroids vs. no steroids, 38.2 vs. 20.2%; P=0.011), including patients with ALF (steroids vs. no steroids, 29.4 vs. 5.1%; P=0.013) and with SALF (steroids vs. no steroids, 52.4 vs. 24.3%; P=0.013), patients with viruses (steroids vs. no steroids, 32.4 vs. 14.1%; P=0.042) and patients without viruses (steroids vs. no steroids, 50.0 vs. 24.1%; P=0.043). SS rates were extremely low for patients with coma grade 4 or Model for End-stage Liver Disease (MELD) scores ≥35 (2.2 vs. 11.8%; P=0.180). A significantly improved rate of SS associated with steroid use was observed among patients who had alanine aminotransferase (ALT) levels ≥30 × the upper limit of normal and coma grade <4 and MELD scores <35 (65.0 vs. 17.4%; P=0.002). SS associated with steroid use was significantly higher in patients with an illness duration ≤2 weeks compared with patients with an illness duration >2 weeks (51.4 vs. 15.0%; P=0.010). Corticosteroids improved the prognosis of patients with ALF and SALF. The highest rates of response were observed in patients with a lower MELD score and coma grade but who had extremely high ALT levels. The most effective treatment time was within 2 weeks of the onset of symptoms.
authors.affiliation: Department of Infectious Diseases, Southwest Hospital, Third Military Medical University, Chongqing 400038, P.R. China.
authors.forename: Bo
authors.initials: B
authors.lastname: Zhao
authors.affiliation: Department of Infectious Diseases, Southwest Hospital, Third Military Medical University, Chongqing 400038, P.R. China.
authors.forename: Hui-Yan
authors.initials: HY
authors.lastname: Zhang
authors.affiliation: Department of Infectious Diseases, Southwest Hospital, Third Military Medical University, Chongqing 400038, P.R. China.
authors.forename: Gui-Juan
authors.initials: GJ
authors.lastname: Xie
authors.affiliation: Department of Infectious Diseases, Southwest Hospital, Third Military Medical University, Chongqing 400038, P.R. China.
authors.forename: Hui-Min
authors.initials: HM
authors.lastname: Liu
authors.affiliation: Department of Infectious Diseases, Southwest Hospital, Third Military Medical University, Chongqing 400038, P.R. China.
authors.forename: Qing
authors.initials: Q
authors.lastname: Chen
authors.affiliation: Department of Infectious Diseases, Southwest Hospital, Third Military Medical University, Chongqing 400038, P.R. China.
authors.forename: Rui-Feng
authors.initials: RF
authors.lastname: Li
authors.affiliation: Department of Infectious Diseases, Southwest Hospital, Third Military Medical University, Chongqing 400038, P.R. China.
authors.forename: Jian-Ping
authors.initials: JP
authors.lastname: You
authors.affiliation: Department of Infectious Diseases, Southwest Hospital, Third Military Medical University, Chongqing 400038, P.R. China.
authors.forename: Sha
authors.initials: S
authors.lastname: Yang
authors.affiliation: Department of Infectious Diseases, Southwest Hospital, Third Military Medical University, Chongqing 400038, P.R. China.
authors.forename: Qing
authors.initials: Q
authors.lastname: Mao
authors.affiliation: Department of Infectious Diseases, Southwest Hospital, Third Military Medical University, Chongqing 400038, P.R. China.
authors.forename: Xu-Qing
authors.initials: XQ
authors.lastname: Zhang
keywords: corticosteroids; hepatic encephalopathy; nucleoside analogues; nucleotide analogues; spontaneous survival; viral hepatitis