Clin Mol Hepatol.  2020 Oct;26(4):639-651. 10.3350/cmh.2020.0196.

Predictors of steroid non-response and new approaches in severe alcoholic hepatitis

• Sarin SK
• Sharma S

• KMID: 2507985
• DOI: http://doi.org/10.3350/cmh.2020.0196

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.

Keyword

Hepatitis, Alcoholic; Steroids; Granulocyte colony-stimulating factor; Microbiota; Microvesicles