Survival and prognostic factors in patients with severe alcoholic hepatitis treated with prednisolone

Background & Aims: Corticosteroids have been shown to significantly decrease short-term mortality in patients with severe alcoholic hepatitis, However, independent factors associated with a favorable outcome and long-term survival are unknown, The aim of this study was to examine prognostic factors and long-term survival in patients with biopsy-proven severe alcoholic hepatitis, Methods: Of 183 patients studied, 61 had been randomized in a previous trial; 32 of them were treated with prednisolone (group I) and 29 were not treated (group II); 61 were treated from the end of this randomized trial (group III); and 61 were simulated (group IV), Results: At 1 year, survival in group 1 (69%; confidence interval [CI], 57%-81%) and group III (71%; CI, 55%-87%) was better than in the nontreated groups (group II, 41%; CI, 23%-59%; P = 0.01) (group IV, 50%; CI, 37%-63%; P = 0.05). At 2 years, survival was not significantly different. Treated patients with marked liver polymorphonuclear infiltrate had better 1-year survival (76%; CI, 64%-88%) than the others (53%; CI, 35%-71%; P = 0.05), Treated patients with polymorphonuclear counts of >5500/mm(3) had better 1-year survival (77%; CI, 65%-89%) than the others (40%; CI, 14%-66%; P = 0.003), In the 93 treated patients, liver polymorphonuclear infiltrate (P < 0.03) and polymorphonuclear count (P < 0.001) were independently correlated with 1-year survival, Conclusions: Prednisolone reduced mortality by at least 1 year, Liver polymorphonuclear infiltrate and polymorphonuclear count were independent prognostic factors.