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PubMed ID:
23929808
Public Release Type:
Journal
Publication Year: 2014
Affiliation: Department of Medicine, Columbia University College of Physicians & Surgeons, New York, NY.
DOI:
https://doi.org/10.1002/hep.26678
Authors:
Pezzia C,
Lalani E,
Samuel G,
Hassanein T,
Satyanarayana R,
Rossaro L,
Stravitz R,
Reddy R,
Munoz S,
Reuben A,
Harrison E,
Crippin J,
Brown R,
Smith A,
Chung RT,
McGuire B,
Fontana R,
Han SH,
Zaman A,
Blei A,
Shaikh A,
Murray N,
Hay J,
McCashland T,
Schilsky M,
Davern T,
Larson AM,
Polson J,
Schiødt FV,
Lee WM,
Ostapowicz GA,
Acute Liver Failure Study Group,
Brown RS Jr,
Lee WM,
Schilsky M,
Stravitz RT,
Chang MS,
Verna EC,
Karkhanis J,
Murray M,
Webster JW,
Smith JP,
Hynan LS,
Reisch JS,
Sanders C
Studies:
Acute Liver Failure Study Group: Adult Acute Liver Failure Study
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.
