Can glucocorticosteroids reduce mortality in patients with alcoholic hepatitis?

Bottom Line:  Glucocorticosteroids has no statistically significant effect on mortality, but there is some evidence that they may reduce mortality in patients with severe alcoholic hepatitis or encephalopathy.

Summary:  Systematic review: glucocorticosteroids for alcoholic hepatitis – a Cochrane Hepato-Biliary Group systematic review with meta-analyses and trial sequential analyses of randomized clinical trials Aliment Pharmacol Ther 2008 Jun;27(12):1167.
Aim: To review randomized clinical trials of glucocorticosteroids vs. placebo or no intervention for patients with alcoholic hepatitis.  Methods: Included randomized trials published before July 2007.  The trials were assessed for risk of bias. Results: Included 15 trials with a total of 721 randomized patients. The overall mortality rate was 39.5%.  Risk of bias occurred in 12 trials.  In all analyses, heterogeneity was significant and substantial.

Glucocorticosteroids did not statistically reduce mortality compared with placebo or no intervention (relative risk 0.83, 95% CI 0.63–1.11).  Glucocorticosteroids significantly reduced mortality in subgroup of trials with patients with Maddrey’s score of at least 32 or hepatic encephalopathy and with low-bias risk.

Repost of February 17, 2010

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