TY - JOUR
T1 - Steroid use in acute liver failure
AU - Karkhanis, Jamuna
AU - Verna, Elizabeth C.
AU - Chang, Matthew S.
AU - Stravitz, R. Todd
AU - Schilsky, Michael
AU - Lee, William M.
AU - Brown, Robert S.
AU - Ostapowicz, George A.
AU - Schiødt, Frank V.
AU - Polson, Julie
AU - Larson, Anne M.
AU - Davern, Timothy
AU - McCashland, Timothy
AU - Eileen Hay, J.
AU - Murray, Natalie
AU - Shaikh, A. Obaid S.
AU - Blei, Andres
AU - Zaman, Atif
AU - Han, Steven H.B.
AU - Fontana, Robert
AU - McGuire, Brendan
AU - Chung, Raymond T.
AU - Smith, Alastair
AU - Brown, Robert
AU - Crippin, Jeffrey
AU - Harrison, Edwin
AU - Reuben, Adrian
AU - Munoz, Santiago
AU - Reddy, Rajender
AU - Rossaro, Lorenzo
AU - Satyanarayana, Raj
AU - Hassanein, Tarek
AU - Samuel, Grace
AU - Lalani, Ezmina
AU - Pezzia, Carla
AU - Sanders, Corron
AU - Reisch, Joan S.
AU - Hynan, Linda S.
AU - Smith, Janet P.
AU - Webster, Joe W.
AU - Murray, Mechelle
PY - 2014/2
Y1 - 2014/2
N2 - 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.
AB - 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.
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U2 - 10.1002/hep.26678
DO - 10.1002/hep.26678
M3 - Article
C2 - 23929808
AN - SCOPUS:84893711001
SN - 0270-9139
VL - 59
SP - 612
EP - 621
JO - Hepatology
JF - Hepatology
IS - 2
ER -