Bilirubin response to corticosteroids in severe alcoholic hepatitis

INTRODUCTION: There is little consensus on the management of alcoholic hepatitis, particularly with regard to corticosteroid therapy. We aimed to identify those patients who respond to corticosteroid therapy for alcoholic hepatitis. METHODS: We identified 37 patients with alcoholic hepatitis with a modified Maddrey's discriminant function of 32 or greater. We assessed their outcomes at 28 and 56 days treatment after admission relative to their response to corticosteroid treatment. RESULTS: Corticosteroid treated patients experienced a change in the serum bilirubin concentration after 6-9 days of -23.0+/-4.7%. Overall, the mortality was 18.9 and 35.1% at 28 and 56 days. Response to corticosteroids was defined as a 25% fall in serum bilirubin after 6-9 days of treatment. The mortality of the non-responders was 36.8% and 57.9% at 28 and 56 days compared with 0% (P=0.0148) and 11.1% (P=0.0084) for corticosteroid responders. CONCLUSIONS: Patients with a 25% fall in bilirubin after 6-9 days of corticosteroid therapy have a significant and sustained improvement in outcome.