Dexamethasone in outcome of patients with hepatitis B virus-related acute-on-chronic liver failure

• Published in: Journal of gastroenterology and hepatology Vol. 29; no. 4; pp. 800 - 806
• Main Authors: Chen, Jun-Feng, Wang, Ke-Wei, Zhang, Shao-Quan, Lei, Zi-Ying, Xie, Jun-Qiang, Zhu, Jian-Yun, Weng, Wei-Zhen, Gao, Zhi-Liang, Lin, Bing-Liang
• Format: Journal Article
• Language: English
• Published: Australia Blackwell Publishing Ltd 01.04.2014
• Subjects: acute liver failure; acute-on-chronic; Adult; Age Factors; Brain Diseases; clinical; dexamethasone; Dexamethasone - administration & dosage; Dexamethasone - therapeutic use; End Stage Liver Disease - drug therapy; End Stage Liver Disease - etiology; End Stage Liver Disease - mortality; End Stage Liver Disease - physiopathology; Female; Follow-Up Studies; Glucocorticoids - administration & dosage; Glucocorticoids - therapeutic use; hepatitis B; Hepatitis B - complications; Humans; Liver Failure, Acute - drug therapy; Liver Failure, Acute - etiology; Liver Failure, Acute - mortality; Liver Failure, Acute - physiopathology; Liver Function Tests; Male; Middle Aged; outcome; Risk Factors; Severity of Illness Index; Survival Rate; Time Factors; Treatment Outcome; dexamethasone; clinical; acute-on-chronic; acute liver failure; hepatitis B; outcome
• ISSN: 0815-9319; 1440-1746; 1440-1746
• DOI: 10.1111/jgh.12454

Background and Aim Acute‐on‐chronic liver failure (ACLF) caused by hepatitis B virus (HBV) is a severe disease with high mortality. Immune injury plays an important role during the early stage of the disease. Our research aimed to investigate the safety and efficacy of dexamethasone therapy for patients with HBV‐related ACLF. Methods A total of 134 inpatients with HBV‐induced ACLF were enrolled from January 2009 to December 2012. All the patients received the standard medicine treatment (SMT), among whom 31 cases underwent additional dexamethasone injection for three times (dexamethasone treatment [DMT] Group). A total of 35 patients (SMT Group) matched for baseline characters served as controls. Both the groups were followed up for 12 weeks. The survival rates, liver functions, and complications were recorded. Results The 12‐week cumulative survival rates were 45.7% (16/35)and 48.4% (15/31) for SMT Group and DMT Group, respectively, and no significant differences were found (P = 0.959). There were no dramatic differences in liver function and model for end‐stage liver disease (MELD) score at 1, 2, 4, 8, and 12 weeks between two groups. There were no significant differences in the incidence of complications (i.e. infection, gastrointestinal bleeding, encephalopathy, hepatorenal syndrome, and ascites) from 1 to 12 weeks between Group SMT and Group DMT. More than 40 ages, MELD score more than 28 and encephalopathy were independent risk factors for the mortality of patients. Conclusions Dexamethasone cannot improve liver functions and 12‐week survival rates of patients with HBV‐related ACLF. Age, MELD score, and encephalopathy are independent risk factors.