Steroid use in acute liver failure

Jamuna Karkhanis, Elizabeth C. Verna, Matthew S. Chang, R. Todd Stravitz, Michael Schilsky, William M. Lee, Robert S. Brown, George A. Ostapowicz, Frank V. Schiødt, Julie Polson, Anne M. Larson, Timothy Davern, Timothy McCashland, J. Eileen Hay, Natalie Murray, A. Obaid S. Shaikh, Andres Blei, Atif Zaman, Steven H.B. Han, Robert FontanaBrendan McGuire, Raymond T. Chung, Alastair Smith, Robert Brown, Jeffrey Crippin, Edwin Harrison, Adrian Reuben, Santiago Munoz, Rajender Reddy, Lorenzo Rossaro, Raj Satyanarayana, Tarek Hassanein, Grace Samuel, Ezmina Lalani, Carla Pezzia, Corron Sanders, Joan S. Reisch, Linda S. Hynan, Janet P. Smith, Joe W. Webster, Mechelle Murray

Research output: Contribution to journalArticle

83 Scopus citations

Abstract

Drug-induced and indeterminate acute liver failure (ALF) might be due to an autoimmune-like hepatitis that is responsive to corticosteroid therapy. The aim of this study was to evaluate whether corticosteroids improve survival in fulminant autoimmune hepatitis, drug-induced, or indeterminate ALF, and whether this benefit varies according to the severity of illness. We conducted a retrospective analysis of autoimmune, indeterminate, and drug-induced ALF patients in the Acute Liver Failure Study Group from 1998-2007. The primary endpoints were overall and spontaneous survival (SS, survival without transplant). In all, 361 ALF patients were studied, 66 with autoimmune (25 steroids, 41 no steroids), 164 with indeterminate (21 steroids, 143 no steroids), and 131 with drug-induced (16 steroids, 115 no steroids) ALF. Steroid use was not associated with improved overall survival (61% versus 66%, P=0.41), nor with improved survival in any diagnosis category. Steroid use was associated with diminished survival in certain subgroups of patients, including those with the highest quartile of the Model for Endstage Liver Disease (MELD) (>40, survival 30% versus 57%, P=0.03). In multivariate analysis controlling for steroid use and diagnosis, age (odds ratio [OR] 1.37 per decade), coma grade (OR 2.02 grade 2, 2.65 grade 3, 5.29 grade 4), MELD (OR 1.07), and pH<7.4 (OR 3.09) were significantly associated with mortality. Although steroid use was associated with a marginal benefit in SS overall (35% versus 23%, P=0.047), this benefit did not persistent in multivariate analysis; mechanical ventilation (OR 0.24), MELD (OR 0.93), and alanine aminotransferase (1.02) were the only significant predictors of SS. Conclusion: Corticosteroids did not improve overall survival or SS in drug-induced, indeterminate, or autoimmune ALF and were associated with lower survival in patients with the highest MELD scores.

Original languageEnglish (US)
Pages (from-to)612-621
Number of pages10
JournalHepatology
Volume59
Issue number2
DOIs
StatePublished - Feb 2014

ASJC Scopus subject areas

  • Hepatology

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    Karkhanis, J., Verna, E. C., Chang, M. S., Stravitz, R. T., Schilsky, M., Lee, W. M., Brown, R. S., Ostapowicz, G. A., Schiødt, F. V., Polson, J., Larson, A. M., Davern, T., McCashland, T., Eileen Hay, J., Murray, N., Shaikh, A. O. S., Blei, A., Zaman, A., Han, S. H. B., ... Murray, M. (2014). Steroid use in acute liver failure. Hepatology, 59(2), 612-621. https://doi.org/10.1002/hep.26678