In the 44th Annual Meeting of the European Association for the Study of Liver (EASL) in Copenhagen, Denmark, a study was presented showing corticosteroids as a possible treatment for patients with severe alcoholic hepatitis, improving their survival rate by as much as a month. In the study, two scales have been developed to gauge the severity of a patient’s disease making it possible to predict which of the patients might respond best to steroid therapy—a treatment considered to be controversial.

According to the results of a meta-analysis presented by Philippe Mathurin, MD, of the Department of Hepatology and Gastroenterology in Hôpital Claude Huriez, Lille, France, patients who have a poor prognosis for survival may benefit from steroid therapy. The study involved 202 patients who were treated with corticosteroids and 185 patients in control groups, and was based on 5 randomised, controlled trials. Patients treated with steroids had a 79.2% over-all 28-day survival rate as opposed to only 64.1% for patients who were mot treated with steroids. Using a univariate analysis, factors that were anticipated of having a poor outcome such as the patient’s age, leucocyte and albumin levels, serum creatine, and the presence of encephalopathy were included. Two scores, the Lille scale and the Maddrey scale of discriminant function (Maddrey DF), were used to measure the severity of the patient’s illness and were also an indication of a poor outcome.

In the Maddrey DF scale, the patient’s bilirubin measurements and prothombin time were considered to determine poor outcome. In this scale, a score of >=32 is considered to be predictive of poor outcome. In the Lille scale, bilirubin, change in bilirubin over a seven-day period, and renal insufficiency were included. 85% of the patients who score >0.45 were predicted to die within 6 months compared to only 25% of those with a score of <0.45.

In the meta-analysis, patients who received steroids had lower levels of bilirubin after a period of seven days, compared to patients who did not receive steroids; the rate was 73.1 mcmol/L for those administered with steroids vs. 36.1 mcmol/L for those who were not administered with steroids. In addition, those who received steroids had a lower Lille score at 0.225, compared to those who did not receive steroids with a score of 0.391.

Another significant finding of the study is that 66.4% of those patients who received steroids were considered as responders to the treatment having Lille scores of less than 0.45, as opposed to 54.6% of those who did not receive steroids treatment.

The meta-analysis also showed that for patients who had Lille scores less than 0.45 at baseline, they had a 94.1% 28-day survival for the patients who received steroid treatment, as opposed to patients who did not receive steroid therapy, having a 78.6% 28-day survival rate where P=.002.

In conclusion, Dr. Philippe Maruthin said that the analysis helps to shed light on the controversy of whether steroids should be used as a treatment for patients with severe alcoholic hepatitis. He also said that the study demonstrates that among a subset of patients that had better Lille scores at baseline, corticosteroid treatment could actually extend 28-day survival.

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