Corticosteroids improve short-term survival in patients with severe alcoholic hepatitis (AH): Individual data analysis of the last three randomized placebo controlled double blind trials of corticosteroids in severe AH

Philippe Mathurin, Charles L. Mendenhall, Robert L. Carithers, Marie Jose Ramond, Willis C. Maddrey, Peter Garstide, Bernard Rueff, Sylvie Naveau, Jean Claude Chaput, Thierry Poynard

Research output: Contribution to journalArticle

278 Scopus citations

Abstract

Background/Aims: Controversy surrounding the efficacy of corticosteroids in severe alcoholic hepatitis (AH) persists. The aims of our study were: (a) to analyze individual data of patients with severe AH discriminant function (DF) ≥32 from the last three randomized controlled trials; and (b) to identify the independent prognostic factors associated with short-term survival. Methods: Individual data were collected from the three principal investigators. Survival analysis was performed at 28 days using the Kaplan-Meier method and log-rank test. The independent prognostic values were assessed by the proportional hazards regression model. Results: About 102 placebo and 113 corticosteroid patients with DF ≥ 32 were analyzed. At 28 days, corticosteroid patients had significantly higher survival: 84.6 ± 3.4% vs. 65.1 ± 4.8%, P = 0.001. In univariate analysis, corticosteroid treatment, age, DF, albumin, creatinine and encephalopathy were prognostic factors. In multivariate analysis, age (P = 0.0001), serum creatinine (P < 0.002) and corticosteroid treatment (P = 0.002) were independent prognostic variables. A more dramatic decrease of median serum bilirubin values (μmol/1) was observed at 7 and 14 days in corticosteroid patients (P < 0.05): -76.5 vs. -35 and -105 vs. -45. Conclusions: Corticosteroids improved short-term survival of patients with severe AH. Age and serum creatinine are independent prognostic factors. Corticosteroids are recommended for patients with severe AH.

Original languageEnglish (US)
Pages (from-to)480-487
Number of pages8
JournalJournal of Hepatology
Volume36
Issue number4
DOIs
StatePublished - Apr 29 2002

Keywords

  • Alcoholic hepatitis
  • Corticosteroids
  • Short-term survival

ASJC Scopus subject areas

  • Hepatology

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