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Predictors of steroid non-response and new approaches in severe alcoholic hepatitis

Severe alcoholic hepatitis (SAH) remains a disease with high mortality. Steroid is the main stay and has been shown to give modest 28-day survival benefit in carefully selected patients, but no 90-day survival benefit. Since non-responders have high incidence of infections and increased mortality, i...

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Autores principales: Sarin, Shiv Kumar, Sharma, Shvetank
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Korean Association for the Study of the Liver 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7641572/
https://www.ncbi.nlm.nih.gov/pubmed/33053936
http://dx.doi.org/10.3350/cmh.2020.0196
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author Sarin, Shiv Kumar
Sharma, Shvetank
author_facet Sarin, Shiv Kumar
Sharma, Shvetank
author_sort Sarin, Shiv Kumar
collection PubMed
description Severe alcoholic hepatitis (SAH) remains a disease with high mortality. Steroid is the main stay and has been shown to give modest 28-day survival benefit in carefully selected patients, but no 90-day survival benefit. Since non-responders have high incidence of infections and increased mortality, it would be worthwhile to identify them before starting steroid therapy. A high and rising bilirubin, urinary acetyl carnitine >2,500 ng/mL, high asiloglycoprotein positive microparticles, and specific features in liver biopsy could predict steroid non-response at baseline. There is an ever-growing need to find new and effective therapies for SAH patients. Besides aggressive nutrition, granulocyte colony stimulating factor, fecal microbiota transplantation, and plasma exchange appear promising therapies and provide a hope for steroid ineligible or steroid non-responsive patients. Suppression of hepatic inflammation, preventing new bacterial or fungal infections, and enhancing liver regeneration will remain the key targets for next generation therapies.
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spelling pubmed-76415722020-11-13 Predictors of steroid non-response and new approaches in severe alcoholic hepatitis Sarin, Shiv Kumar Sharma, Shvetank Clin Mol Hepatol Review Severe alcoholic hepatitis (SAH) remains a disease with high mortality. Steroid is the main stay and has been shown to give modest 28-day survival benefit in carefully selected patients, but no 90-day survival benefit. Since non-responders have high incidence of infections and increased mortality, it would be worthwhile to identify them before starting steroid therapy. A high and rising bilirubin, urinary acetyl carnitine >2,500 ng/mL, high asiloglycoprotein positive microparticles, and specific features in liver biopsy could predict steroid non-response at baseline. There is an ever-growing need to find new and effective therapies for SAH patients. Besides aggressive nutrition, granulocyte colony stimulating factor, fecal microbiota transplantation, and plasma exchange appear promising therapies and provide a hope for steroid ineligible or steroid non-responsive patients. Suppression of hepatic inflammation, preventing new bacterial or fungal infections, and enhancing liver regeneration will remain the key targets for next generation therapies. The Korean Association for the Study of the Liver 2020-10 2020-10-01 /pmc/articles/PMC7641572/ /pubmed/33053936 http://dx.doi.org/10.3350/cmh.2020.0196 Text en Copyright © 2020 by The Korean Association for the Study of the Liver This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Review
Sarin, Shiv Kumar
Sharma, Shvetank
Predictors of steroid non-response and new approaches in severe alcoholic hepatitis
title Predictors of steroid non-response and new approaches in severe alcoholic hepatitis
title_full Predictors of steroid non-response and new approaches in severe alcoholic hepatitis
title_fullStr Predictors of steroid non-response and new approaches in severe alcoholic hepatitis
title_full_unstemmed Predictors of steroid non-response and new approaches in severe alcoholic hepatitis
title_short Predictors of steroid non-response and new approaches in severe alcoholic hepatitis
title_sort predictors of steroid non-response and new approaches in severe alcoholic hepatitis
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7641572/
https://www.ncbi.nlm.nih.gov/pubmed/33053936
http://dx.doi.org/10.3350/cmh.2020.0196
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