Corticoids in severe alcoholic hepatitis in patients with cirrhosis and contraindications to receiving corticoids: a retrospective study of patients admitted in a reference hospital

• Grant number: 19/07869-9
• Support Opportunities: Scholarships in Brazil - Scientific Initiation
• Effective date (Start): October 01, 2019
• Effective date (End): September 30, 2020
• Field of knowledge: Health Sciences - Medicine - Medical Clinics
• Principal Investigator: Fernando Gomes Romeiro
• Grantee: Fábio Luís Argentieri Cunha
• Host Institution: Faculdade de Medicina (FMB). Universidade Estadual Paulista (UNESP). Campus de Botucatu. Botucatu , SP, Brazil

Abstract

Alcoholic hepatitis (AH) is a highly prevalent disease in patients addicted to alcohol. AH mortality is high, ranging from 30-50% during the first 28 days of hospitalization. The signs and symptoms are varied and not very specific because many of them can be already seen in cirrhotic patients. Laboratory tests are essential for grading AH severity, thus indicating a liver biopsy only if the diagnosis is not clear. The AH severity is graded through several indexes calculated from clinical and laboratory parameters. The most used are the Maddrey's discriminant function (Maddrey's DF) and the ABIC (Age, serum Bilirubin, International Normalized Ratio, and Creatinine) indexes. However, none of them specifies the best treatment for each patient, which is a controversial issue. The therapy consists of alcohol abstinence, adequate nutritional therapy, and a drug. The most used drugs are corticosteroids and pentoxifylline, but there is no consensus on the best option for each case. Common complications such as digestive bleeding, infections, and renal failure can preclude the use of corticosteroids, making pentoxifylline (or only the supportive treatment) the only option. However, the best choice for these cases is still not clear. The aim of this study is to make a retrospective comparison between results obtained with or without the use of corticosteroids for cirrhotic patients with renal failure, digestive bleeding or infections who were hospitalized because of AH in a reference center. It is expected to obtain relevant data on the frequency of corticosteroids usage, the reasons for their withdrawal, and the outcomes achieved when these drugs are used or not. Mortality rates, secondary infections, and other findings will be evaluated as well. (AU)