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Evidence summaries

Glucocorticoids in Alcoholic Hepatitis

Prednisolone (a one-month course of 40 mg a day) appears to decrease mortality in patients with severe alcoholic hepatitis. Level of evidence: "B"

A systematic review 1 including 13 studies with a total of 659 subjects was abstracted in DARE. The pooled relative risk of death was 0.62 (95% CI 0.38 to 1.05). The results are suggestive of a publication bias; studies with a high weight (larger sample size) showing no therapeutic effect and those with a low weight showing an effect. There was heterogeneity between trials.

Another systematic review 2 including 3 high quality randomized, placebo-controlled trials found that corticosteroids improved survival at 28 days in patients with severe alcoholic hepatitis (84.6% vs 65.1%, p=0.001).

Comment: The quality of evidence is downgraded by possibility of reporting bias.

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    References

    • Christensen E, Gluud C. Glucocorticoids are ineffective in alcoholic hepatitis: a meta-analysis adjusting for confounding variables. Gut 1995 Jul;37(1):113-8. [PubMed] [DARE]
    • Mathurin P, Mendenhall CL, Carithers RL Jr, Ramond MJ, Maddrey WC, Garstide P, Rueff B, Naveau S, Chaput JC, Poynard T. Corticosteroids improve short-term survival in patients with severe alcoholic hepatitis (AH): individual data analysis of the last three randomized placebo controlled double blind trials of corticosteroids in severe AH. J Hepatol 2002 Apr;36(4):480-7. [PubMed]

Primary/Secondary Keywords