Efficiency of glucocorticosteroids in severe alcoholic hepatitis
https://doi.org/10.21518/ms2022-055
Abstract
Introduction. The feasibility and risks of glucocorticosteroids (GCS) in severe alcoholic hepatitis (SAH) are actively discussed, and there is a real need to develop new biomarkers both to determine indications for the GCS use and to evaluate their effectiveness.
Аim. Тo evaluate the effectiveness of GCS in SAH using a marker of hepatocyte apoptosis and inflammatory cytokines along with traditional laboratory parameters.
Materials and methods. Prednisolone at a dose of 40 mg per day was received by 68 patients with SAH. The effectiveness of therapy was assessed after 7 days by the Lille index, the level of cytokeratin-18 fragments (FCK-18) and cytokines – IL-1β, TNF-α, IL-6 and IL-8.
Results. A positive effect of GCS was noted in 50 (73.5%) patients, after 7 days the Lille index was 0.23 ± 0.09, the levels of FCK18, IL-6, IL-8, TNF-α were significantly reduced, with subsequent decrease and improvement in hepatic functional parameters. These patients had a 100% short-term (within 28 days) survival rate. Eighteen (26.5%) patients had a negative result, the Lille index was 0.61 ± 0.11, there was no significant decrease in FCK-18 and cytokines. After GCS was discontinued, they developed liver failure, 1/3 developed bacterial infections, all patients died of multiple organ failure within 28 days.
Conclusion. The short-term effect of GCS therapy in SAH patients was 73.5%. Along with the traditional Lille index, the following indicators demonstrated diagnostic significance: fragments of cytokeratin-18, cytokines IL-6, IL-8, and, to a lesser extent, TNF-α and IL-1β.
Supporting agencies: This work was conducted with financial support from the Ministry of Science and Higher Education of the Russian Federation on the topics No. 075-15-2021-665, No. FMEN-2022-0009 (No. g.r. 122031100064-4).
About the Authors
A. S. Rodina
Petrozavodsk State University
Russian Federation
Russian Federation
Alisa S. Rodina, Рostgraduate Student of the Department of Propaedeutics of Internal Diseases and Hygiene
33, Lenin Аve, Petrozavodsk, 185910
I. V. Kurbatova
Karelian Research Centre of the Russian Academy of Sciences
Russian Federation
Russian Federation
Irina V. Kurbatova, Cand. Sci. (Biol.), Senior Researcher at the Genetics Laboratory of the Institute of Biology
11, Pushkinskaya St., Petrozavodsk, 185910
M. E. Shubina
Petrozavodsk State University
Russian Federation
Russian Federation
Marina E. Shubina, Cand. Sci. (Med.), Associate Professor of the Department of Propaedeutics of Internal Diseases and Hygiene
33, Lenin Аve, Petrozavodsk, 185910
O. P. Dudanova
Petrozavodsk State University
Russian Federation
Russian Federation
Olga P. Dudanova, Dr. Sci. (Med.), Professor, Head of the Department of Propaedeutics of Internal Diseases and Hygiene
33, Lenin Аve, Petrozavodsk, 185910
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For citations:
Rodina AS, Kurbatova IV, Shubina ME, Dudanova OP. Efficiency of glucocorticosteroids in severe alcoholic hepatitis. Meditsinskiy sovet = Medical Council. 2023;(8):135-141. (In Russ.) https://doi.org/10.21518/ms2022-055
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