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: