Predictors of steroid non-response and new approaches in severe alcoholic hepatitis
- Author:
Shiv Kumar SARIN
1
;
Shvetank SHARMA
Author Information
- Publication Type:Special topic: Alcoholic liver diseases The 14th International Symposium on Alcoholic Liver and
- From:Clinical and Molecular Hepatology 2020;26(4):639-651
- CountryRepublic of Korea
- Language:English
- Abstract: Severe alcoholic hepatitis (SAH) remains a disease with high mortality. Steroid is the main stay and has been shown to give modest 28-day survival benefit in carefully selected patients, but no 90-day survival benefit. Since non-responders have high incidence of infections and increased mortality, it would be worthwhile to identify them before starting steroid therapy. A high and rising bilirubin, urinary acetyl carnitine >2,500 ng/mL, high asiloglycoprotein positive microparticles, and specific features in liver biopsy could predict steroid non-response at baseline. There is an ever-growing need to find new and effective therapies for SAH patients. Besides aggressive nutrition, granulocyte colony stimulating factor, fecal microbiota transplantation, and plasma exchange appear promising therapies and provide a hope for steroid ineligible or steroid non-responsive patients. Suppression of hepatic inflammation, preventing new bacterial or fungal infections, and enhancing liver regeneration will remain the key targets for next generation therapies.
