The use of corticosteroids in severe alcohol hepatitis: we need to look beyond this controversy.

摘要

The efficacy of corticosteroids in alcoholic hepatitis remains controversial for some authors. Three meta-analyses of the literature, from three different groups, concluded that the survival effect of corticosteroids was restricted to patients with severe disease. Conversely, two other meta-analyses of the literature from the same group questioned the efficacy of corticosteroids in alcoholic hepatitis, regardless of disease severity, although their latest meta-analysis observed that corticosteroids reduced mortality significantly in the subgroup of trials in patients with Maddrey discriminant function >=32 or hepatic encephalopathy [1], Unexpectedly, their latest meta-analysis included some inaccuracies: (i) the authors considered Richardet's study to be a trial comparing corticosteroids with no treatment, whereas both arms were treated with corticosteroids (information provided by Dr. Richar-det); (ii) mortality data in the short-term were mixed with long-term mortality data; and (iii) the authors included a study (Gal-ambos) quoted by another author (Conn) that has never been published even in abstract form.