Efficiency of glucocorticosteroids in severe alcoholic hepatitis

Abstract

Introduction. The feasibility and risks of glucocorticosteroids (GCS) in severe alcoholic hepatitis (SAH) are actively discussed, and there is a real need to develop new biomarkers both to determine indications for the GCS use and to evaluate their effectiveness. Аim. Тo evaluate the effectiveness of GCS in SAH using a marker of hepatocyte apoptosis and inflammatory cytokines along with traditional laboratory parameters. Materials and methods. Prednisolone at a dose of 40 mg per day was received by 68 patients with SAH. The effectiveness of therapy was assessed after 7 days by the Lille index, the level of cytokeratin-18 fragments (FCK-18) and cytokines – IL-1β, TNF-α, IL-6 and IL-8. Results. A positive effect of GCS was noted in 50 (73.5%) patients, after 7 days the Lille index was 0.23 ± 0.09, the levels of FCK18, IL-6, IL-8, TNF-α were significantly reduced, with subsequent decrease and improvement in hepatic functional parameters. These patients had a 100% short-term (within 28 days) survival rate. Eighteen (26.5%) patients had a negative result, the Lille index was 0.61 ± 0.11, there was no significant decrease in FCK-18 and cytokines. After GCS was discontinued, they developed liver failure, 1/3 developed bacterial infections, all patients died of multiple organ failure within 28 days. Conclusion. The short-term effect of GCS therapy in SAH patients was 73.5%. Along with the traditional Lille index, the following indicators demonstrated diagnostic significance: fragments of cytokeratin-18, cytokines IL-6, IL-8, and, to a lesser extent, TNF-α and IL-1β.