Glucocorticoid treatment appears to be more effective for reducing total bilirubin level, significantly decreasing in-hospital mortality and ascites events in hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF) patients, suggested a systematic review and meta-analysis published recently in Medicine (Baltimore).

The meta-analysis was conducted to determine the efficacy and safety of glucocorticoid compared to traditional therapy for HBV-related ACLF. Investigators searched PubMed, Cochrane Central Register of Clinical Trials, and EMBASE and all clinical studies, including randomized controlled studies and cohort studies, comparing glucocorticoids with traditional treatments (until November 1, 2018), were included in the analysis.

Thee randomized controlled trials and 5 cohort studies (including 3 retrospective cohort studies), including 538 patients, were part of the meta-analysis. Total bilirubin levels prior to treatment were not significantly different (odds ratio [OR]: -0.97; 95% confidence interval [CI]: -2.56 to 0.62; P = .23), but were significantly reduced after treatment in the corticosteroid group compared to the traditional treatment group (OR: -8.83; 95% CI: -14.99 to 2.67; P = .005). Prothrombin time was significantly long before treatment in either group and there were no significant differences (OR: 0.28; 95% CI: -0.79 to 1.34; P = 0.61). Following treatment, prothrombin time was significantly decreased in the traditional treatment group (OR: 31.71; 95% CI: 3.62-59.81; P = .03). Inpatient mortality (OR: 0.23; 95% CI: 0.08-0.67; P = .007) and ascites events (OR: 0.35; 95% CI: 0.18-0.67; P = .90) were noted to be significantly lower in the corticosteroid treatment group.

Glucocorticoid treatment was thus more effective for reducing bilirubin level, decreasing in-hospital mortality and ascites events in HBV-related ACLF patients.

Source: Gao R, Li Y, Cao Y, et al. Glucocorticoid Versus Traditional Therapy for Hepatitis B Virus-Related Acute-On-Chronic Liver Failure: A Systematic Review and Meta-Analysis. Medicine (Baltimore). 2020 Jun 19;99(25):e20604.