Mortality Improvement with Corticosteroids Treatment in Patients with Alcoholic Hepatitis

Improvement in short-term mortality was seen in patients who receive corticosteroids for treatment of severe alcoholic hepatitis without an increased risk of infection occurrence, according to results of a meta-analysis of randomized controlled trials that was presented during a poster session at the 2013 American College of Gastroenterology annual meeting in San Diego, CA.

Bashar Hmoud, MD, and colleagues at the University of Texas Medical Branch in Galveston, Texas, performed a meta-analysis of 10 randomized controlled trials to assess corticosteroids in patients with severe alcoholic hepatitis in relation to infection occurrence and infection-related mortality. They also looked at overall mortality, mortality from gastrointestinal bleed (GIB) or from acute liver failure and/or hepatorenal syndrome (ALF/HRS).

A first-line therapy for alcoholic hepatitis, corticosteroids treatment provides only a 50 percent survival rate and raises concern among doctors of possibly infecting a sick population, noted study authors. The study aimed to assess use of the treatment and its impact on infection occurrence and infection-related mortality.

The analysis compared 257 patients who were treated with corticosteroids to a group of 255 who were treated with placebo. The difference in occurrence of infection was 19 percent versus 20 percent, respectively.

Five patients from the corticosteroids group and one in the placebo group developed fungal infection. Two patients from the corticosteroids group developed disseminated infection. Similarities in infections of sepsis (21 vs. 23), urinary tract infection (9 vs. 11), pneumonia (7 vs. 9), SBP (6 vs. 6), and cellulitis (1 vs. 2) were seen in both groups.

There were four studies that recorded a median time to infection of 12 to 34 days among the corticosteroids group and 7 to 66 days among patients who received placebo. There were 179 deaths among patients by the 28^th day of treatment and 75 of those patients had been treated with corticosteroids.

The lower mortality rate among the corticosteroids-treated group (0.54 [0.36-0.81]) was mostly because of prevention of death due to ALF/HRS (8 percent vs. 15 percent, 0.44 [0.22-0.86]) and no difference from GIB (8 percent vs. 8 percent, 1.07 [0.54-2.13]) or infection (10 percent vs. 13 percent, 0.88 [0.28-2.72]). Of all the deaths, proportional mortality from infection, GIB, and ALF/HRS were no different between the two groups.

Researchers concluded from the study results that corticosteroids improve short-term mortality in patients with severe alcoholic hepatitis. A beneficial effect of corticosteroids treatment was the result of reduced deaths from ALF/HRS without an overall increase in the risk of infection or infection related mortality. The authors propose prospective studies to examine antifungal prophylaxis and predictors of occurrence of infection in order to optimize use of corticosteroids for the treatment of alcoholic hepatitis.