Efficacy of low-dose glucocorticoids in treatment of HBV-related acute-on-chronic liver failure

Objective To investigate the efficacy and safety of low- dose glucocorticoids in the treatment of HBV- related acute- on-chronic liver failure( HBV- ACLF). Methods A total of 118 patients with HBV- ACLF who were treated in Center for Liver Disease Treatment in the Fourth People's Hospital of Panzhihua from January 2012 to October 2015 were enrolled and randomly divided into treatment group and control group,with 59 patients in each group. All the patients were given antiviral therapy with entecavir and conventional liver-protecting and symptomatic treatment,and the patients in the treatment group were given intravenous drip of low- dose hydrocortisone sodium succinate( 25 mg / d) in addition. The clinical manifestations,biochemical parameters for liver function,adverse events,length of hospital stay,and hospital costs were recorded for all patients. The t- test was used for comparison of continuous data between groups,the paired t- test was used for comparison of continuous data within groups,and the chi- square test or Fisher's exact test was used for comparison of categorical data between groups. Results At the end of the course of the treatment,the treatment group showed significantly better improvements in the biochemical parameters for liver function( alanine aminotransferase,aspartate aminotransferase,total bilirubin,albumin,cholinesterase,and prothrombin activity) compared with the control group( all P < 0. 001). The treatment group had a significantly shorter length of hospital stay and significantly lower hospital costs than the control group( length of hospital stay: 48. 0 ± 9. 2 d vs 74. 0 ± 16. 4 d,t = 4. 34,P < 0. 01; hospital costs: 7974. 5 ± 853. 7 RMB / person vs 12 432. 7 ± 1263. 1 RMB / person,t = 22. 46,P < 0. 01). No patients in the treatment group experienced adverse events related to hydrocortisone sodium succinate. Conclusion In the treatment of HBV- ACLF,low- dose hydrocortisone sodium succinate can eliminate jaundice,alleviate conditions,and improve the prognosis. Meanwhile,it can also shorten the length of hospital stay and reduce hospital costs. This drug has good safety and holds promise for further clinical research.