Efficacy of short-term dexamethasone therapy in acute-on-chronic pre-liver failure.
Zhang XQ, Jiang L, You JP, Liu YY, Peng J, Zhang HY, Xu BY, Mao Q.
Hepatol Res. 2011 Jan;41(1):46-53. doi: 10.1111/j.1872-034X.2010.00740.x. Epub 2010 Oct 25.
Department of Infectious Diseases, Southwest Hospital, Third Military Medical University, Chongqing, China.
Acute-on-chronic pre-liver failure (pre-ACLF) is defined as a severe acute episode of chronic hepatitis B characterized by serum bilirubin of 171 µmol/L or more, alanine aminotransferase of five times or more the upper limit of normal and prothrombin activity of more than 40%, having a potential for progression to acute-on-chronic liver failure (ACLF). This study is to evaluate the efficacy of short-term dexamethasone in pre-ACLF.
One hundred and seventy patients were assigned to dexamethasone therapy and control group at a ratio of 1:2. For the two groups, we compared biochemical indicators, the incidence of ACLF and mortality. The influential factors on the mortality of patients with pre-ACLF were studied by Cox proportional hazards models. Results: The significantly lower incidence of ACLF and higher survival rate were observed in patients on dexamethasone therapy (8.9%, 96.4%, respectively) than in control patients (70.2%, 52.6%, respectively; P < 0.001). Dexamethasone treatment was an independent factor influencing the survival rate (P < 0.001, odds ratio = 0.055, 95% confidence interval = 0.013-0.225). During 4 weeks of treatment, serum bilirubin levels of survival patients were significantly lower in the dexamethasone group than control group. Conclusion: Five-day dexamethasone therapy is effective in improving the liver function and survival rate of patients with pre-ACLF.