Glucocorticoids improve the outcomes of patients in the pre- and early stages of acute-on-chronic liver failure

Abstract

Abstract: Objective To study on the clinical efficacy and safety of glucocorticoid (GC) in the treatment of patients with acute-on-chronic pre-liver failure (pre-ACLF) or acute-on-chronic liver failure in the early stage. Methods The data of patients with pre-ACLF or acute-on-chronic liver failure in the early stage hospitalized in Taihe Hospital of Shiyan City from Jan. 2009 to Dec. 2021 were retrospectively analyzed. Patients received standard medical therapy (SMT) were enrolled into a SMT group, and those received glucocorticoid (GC) based on SMT treatment were enrolled into a SMT+GC group. By using propensity score matching (PSM) method. The incidences of ACLF and complications, and short-term survival rates (28 days, 90 days, 1 year) were analyzed. Methods A total of 177 patients with pre-ACLF or ACLF in early stage were included in this study, including 132 patients in the SMT group and 45 cases in the SMT+GC group. There was no statistical difference in baseline data comparison between the SMT+GC group and SMT group after PSM matching. Compared with those who received SMT treatment only, patients received SMT+GC combination treatment showed significantly higher 1-year survival rate (93.2% vs. 75.0%, P=0.020), and in hospital improvement rate (84.4% vs. 66.4%,P=0.03). On the other hand, Prothrombin Activity (PTA), Prothrombin Time (PT), and International Normalized Ratio (INR) in SMT+GC group improved significantly on the 7th day (P<0.05). Attractively, significantly less pre-ACLF patients developed ACLF if they received SMT+GC combination treatment (6.66% vs. 34.48%, P=0.008). There was no significant difference in the incidence of complications between SMT+GC group and SMT group (P>0.05). Conclusion GC can effectively block the deterioration of patients with pre-ACLF or ACLF in early stage, especially circumvent the development of ACLF in pre-ACLF patients. It may improve the survival of patients without increasing the incidence of complications.

Key words: Glucocorticoid, Acute-on-chronic liver failure, Acute-on-chronic pre-liver failure, Treatment

DENG Ru-xin, LEI Si-xian, Meng Zhong-ji. Glucocorticoids improve the outcomes of patients in the pre- and early stages of acute-on-chronic liver failure[J]. Chinese Hepatolgy, 2025, 30(1): 31-36.

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