TITLE

IDENTIFICATION OF CORTICOSTEROID RESPONDERS IN THE TREATMENT OF ACUTE ALCOHOLIC HEPATITIS

AUTHOR(S)
Morris, J.M.; Forrest, E.H.
PUB. DATE
April 2003
SOURCE
Gut;Apr2003 Supplement 1, Vol. 52, pA103
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Up to 60% of patients with acute alcoholic hepatitis (AAH) die within 30 days. Despite numerous trials concerning the use of corticosteroids (CS) for this condition considerable debate remains. In our experience some patients with AAH have a dramatic biochemical response to CS. Aim: The aim of this study was to identify CS responders, and to determine if this response was predictable and related to outcome. Methods: Clinical and laboratory details of 27 episodes (23 individual patients) of AAH treated with CS (prednisolone 40 mg) were recorded retrospectively. CS response was defined as a 25% reduction in serum bilirubin (SB) after 6-9 days of treatment. Comparisons were made with a historical control group of 30 episodes of AAH not treated with CS. Results: CS response was seen in 15 episodes (55.5%). Mean percentage fall in SB was greater for CS treated patients compared with non-CS treated controls (-30.8 ± 4.7% cf +0.7 ± 5.6%; p < 0.001). Leucocytosis on initiation of CS treatment was more marked in CS responders compared with non-responders (19.5 ± 3.1 cf 11.7 ± 1.0; p < 0.05). Mortality is shown in the table. There was no difference in the incidence of documented sepsis between CS treated and non-CS treated controls. Conclusions: Approximately half of the patients with AAH will respond to CS treatment with a 25% reduction in SB after one week. Patients with a leucocytosis are more likely to respond. These responders appear to have a significantly improved survival. Non-responders at one week need not persist with CS treatment.
ACCESSION #
9747988

 

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