Corticosteroid improves liver function but does not curb the clinical progression of hepatitis B virus-related acute-on-chronic pre-liver failure

ABSTRACT

Background: Hepatitis B virus-related acute-on-chronic pre liver failure (HBV pre-ACLF) has the potential for progression to HBV ACLF. Whether corticosteroid is useful for HBV pre-ACLF remains heterogeneous. This study aimed to evaluate the efficacy of short-term (5 days) and low-dose dexamethasone (5mg/d) toward HBV pre-ACLF.

Design and methods: One hundred twenty-one patients with HBV pre-ACLF were randomly divided into two groups: medical comprehensive treatment (MCT) group and corticosteroid treatment (CT) group. Laboratory measurements at admission and 7 days post-admission were compared between the two groups, respectively. Hospitalization periods and clinical progression were also monitored and compared between the two groups.

Results: Higher than normal levels of ALT, AST, TBIL, DBIL, TBA and GLO were observed at 7 days after admission in patients in the MCT group than in CT group (p < 0.001).Patients in the CT group had shorter inpatient days than the MCT group (p = 0.002).During hospitalization and treatment, the incidence of HBV ACLF was not substantially different between the two groups (14.8% vs. 8.3%, p = 0.271).

Conclusions: Corticosteroid is effective at improving the liver function and decreasing hospitalization periods of patients with HBV pre-ACLF but does not prevent HBV pre-ACLF from progressing to HBVACLF.

KEYWORDS:

• Acute-on-chronic
• corticosteroid
• hepatitis B virus
• pre liver failure
• prognosis

Article highlights

• Etiological treatment can’t curb the progression of HBV pre-ACLF.

• A ‘golden week’ within 7 days after admission should be monitored among HBV pre-ACLF.

• Hospitalization period can be decreased with corticosteroids.

• Corticosteroid is effective at improving the liver function and decreasing hospitalization period of patients with HBV pre-ACLF but does not prevent HBV pre-ACLF from progressing to HBVACLF.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Data availability

Data presented in this study are available from the corresponding author upon reasonable request.

Additional information

Funding

This study was supported by the Chongqing Municipal Health and Family Planning Commission of China (grant number 2016ZDXM038).