Clinical Advances in Liver, Pancreas, and Biliary TractInfection in Patients With Severe Alcoholic Hepatitis Treated With Steroids: Early Response to Therapy Is the Key Factor
Section snippets
Infection Screening and Treatment Protocol
From April 2002 to August 2008, all patients admitted to the Hepatology Unit of Hôpital Huriez, Lille, were systematically evaluated for infection at the time of admission. Criteria for treatment with corticosteroids were the following: (1) severity of AH defined by Maddrey score ≥32; (2) recent onset of jaundice (less than 3 months); (3) history of long-standing alcoholism; (4) liver chemistry suggestive of severe AH; (5) absence of recent gastrointestinal hemorrhage (ie, <15 days); and (6)
Characteristics of the Study Population
Two hundred forty-six patients with severe AH were prospectively included. Clinical and biologic characteristics are given in Table 1. One- and 2-month survival were 85.5% ± 3% and 72.2% ± 3%, respectively. Among the 246 patients, corticosteroids were given to 240 patients, and 6 early deaths (5 related to infection) precluded initiation of corticosteroids. In the 240 patients receiving corticosteroids, Maddrey scores calculated at admission and at start of corticosteroids were not
Discussion
The comprehensiveness of pathogenesis of infection in patients with severe AH treated with corticosteroids appears more complex than classically believed. In the present study, we observed that (1) infection is frequent in severe AH; (2) corticosteroid treatment is not associated with a higher risk of infection, and its use should not be precluded in already infected patients after appropriate and effective antibiotherapy; (3) nonresponse to corticosteroids is the main factor contributing to
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Conflicts of interest The authors disclose no conflicts.