Clinical

Bilirubin response to steroids predicts alcoholic hepatitis outcome

Last Updated: 2005-07-29 15:16:00 -0400 (Reuters Health)

NEW YORK (Reuters Health) - A drop in bilirubin levels after just a few days of corticosteroid therapy is associated with decreased mortality in patients with severe alcoholic hepatitis, Scottish researchers report.

The decision to use steroids for alcoholic hepatitis is controversial, Dr. Ewan H. Forrest and Dr. Judith M. Morris, from Glasgow Royal Infirmary, note in the European Journal of Gastroenterology and Hepatology for July. The present results suggest that a 6- to 9-day trial of these agents is warranted in patients without obvious contraindications.

The findings are based on a study of 37 patients with acute alcoholic hepatitis. The investigation focused on 18 of the patients who were treated with corticosteroids.

The overall mortality rates at 28 and 56 days were 18.9% and 35.1%, respectively, the report indicates.

Seven of the corticosteroid-treated patients had a treatment response, defined as a 25% or greater drop in bilirubin levels after 6 to 9 days of therapy. The remaining 11 patients were considered nonresponders.

The bilirubin response to steroids was predictive of mortality at 28 and 56 days. The mortality rates for nonresponders at 28 and 56 days were 36.8% and 57.9%, respectively, while the corresponding rates for responders were much lower -- 0% and 11.1% (p < 0.05 for both).

The clinical implication of these findings is that responders should continue to receive a full course of steroid therapy, the authors conclude, whereas steroid withdrawal is indicated for nonresponders, which would help reduce toxicity and allow for treatment with other agents.

Eur J Gastroenterol Hepatol 2005;17:759-762.