Corticosteroids improved short-term mortality in severe alcoholic hepatitis patients

SAN DIEGO — Concerns over potential infections brought on by the use of corticosteroids among severe alcoholic hepatitis patients are unwarranted, Bashar S. Hmoud, MD, chief resident at the University of Texas Medical Branch said during the American College of Gastroenterology Annual Scientific Meeting.

“We shouldn’t be afraid of treating patients with alcoholic hepatitis with steroids, as it will not increase the risk of infection,” he said.

Researchers conducted a meta-analysis of 10 randomized controlled trials to primarily determine the impact of corticosteroids on infection occurrence and infection-related mortality in severe alcoholic hepatitis patients without infection at baseline.

The meta-analysis examined 257 patients treated with corticosteroids and 255 with placebo and found similar numbers for infection (19% vs. 20%; OR=0.82; 95% CI, 0.5-1.37). Specific infection results also were similar between corticosteroid and placebo patients, respectively: 21 vs. 23 with sepsis, 9 vs. 11 with urinary tract infection, 7 vs. 9 with pneumonia, 6 vs. 6 with spontaneous bacterial peritonitis and 1 vs. 2 with cellulitis.

Five corticosteroid patients developed fungal infections with two developing disseminated infection, compared with one fungal infection among placebo patients.

In the four studies that tracked it, median time until report of an infection was 12 to 34 days in the corticosteroid group and 7 to 66 days for the placebo group.

By the 28th day of treatment, 75 corticosteroid patients had died, compared with 104 of the placebo patients. The lower rate among corticosteroid users primarily was attributed to prevention of acute liver failure/hepatorenal syndrome, the study found. There was no impact on deaths from gastrointestinal bleeding or infection.

The reduction in short-term deaths without increased risk for infection or infection-related mortality demonstrates the beneficial effect of corticosteroids in this group, researchers said. Additional prospective studies into antifungal prophylaxis and predictors of occurrence of infection would be valuable, they concluded.

Disclosure: Hmoud reported no relevant financial disclosures.

For more information:

Hmoud BS. #853: Corticosteroids Do Not Increase the Risk of Infection Occurrence or Infection-related Mortality amongst Patients with Severe Alcoholic Hepatitis. Presented at: the 2013 American College of Gastroenterology Annual Scientific Meeting; Oct. 11-16, San Diego.

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