Steroid therapy in alcoholic hepatitis: when enough is enough ▸

Without specific treatment, up to 50% of patients with severe alcoholic hepatitis will die within two months. Although the efficacy of corticosteroid therapy in reducing mortality from alcoholic hepatitis has been demonstrated in some randomised placebo controlled trials, meta-analyses have drawn conflicting conclusions. One of the concerns of treating patients with 40 mg of prednisolone for 28 days is that of susceptibility to infection, which is a frequent cause of mortality in this group. Therefore, early identification of those who would not benefit from steroid therapy would be clinically helpful.

Mathurin et al included 238 patients with histologically proven alcoholic hepatitis and a discriminant function of ⩾32 treated with steroids in the analysis. Overall, 73% of patients had a reduction in bilirubin after seven days of steroid therapy compared with that at the …