Do corticosteroids reduce mortality from alcoholic hepatitis? A meta-analysis of the randomized trials

T. F. Imperiale, A. J. McCullough

Research output: Contribution to journalArticle

226 Citations (Scopus)

Abstract

Purpose: To determine whether corticosteroids affect short-term mortality from alcoholic hepatitis. Data Identification: Studies published from 1966 to 1989 were identified through a MEDLINE computer search and an extensive manual search of the bibliographies of identified articles. Study Selection: We found 11 randomized studies (10 of which were placebo controlled) that assessed mortality in hospitalized patients diagnosed with acute alcoholic hepatitis and treated with corticosteroids. Data Extraction: Two critical appraisers independently evaluated trial quality and abstracted quantitative data on clinical characteristics of the populations, interventions, and all-cause mortality. Results of Data Synthesis: Overall, the protective efficacy (or percent reduction in mortality) of corticosteroids was 37% (95% CI, 20% to 50%). Protective efficacy was higher among trials with higher quality scores and trials that excluded subjects with active gastrointestinal bleeding. In subjects with hepatic encephalopathy, protective efficacy was 34% overall (CI, 15% to 48%). It was also higher among trials with higher quality scores and trials excluding subjects with acute gastrointestinal bleeding, but was not present among trials with lower quality scores or trials that did not exclude subjects with acute gastrointestinal bleeding. In subjects without hepatic encephalopathy, corticosteroids had no protective effect, and this lack of efficacy was consistent across all trial subgroups. Conclusions: These results suggest that corticosteroids reduce short-term mortality in patients with acute alcoholic hepatitis who have hepatic encephalopathy, that the protective effect depends on the exclusion criterion of acute gastrointestinal bleeding and is influenced by trial quality, and that corticosteroids are of no benefit in patients without hepatic encephalopathy.

Original languageEnglish (US)
Pages (from-to)299-306
Number of pages8
JournalAnnals of Internal Medicine
Volume113
Issue number4
StatePublished - Aug 15 1990
Externally publishedYes

Fingerprint

Alcoholic Hepatitis
Meta-Analysis
Adrenal Cortex Hormones
Hepatic Encephalopathy
Mortality
Hemorrhage
Bibliography
Population Characteristics
MEDLINE
Placebos

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Do corticosteroids reduce mortality from alcoholic hepatitis? A meta-analysis of the randomized trials. / Imperiale, T. F.; McCullough, A. J.

In: Annals of internal medicine, Vol. 113, No. 4, 01.01.1990, p. 299-307.

Research output: Contribution to journalArticle

@article{7357125191614921ba8fc69859671129,
title = "Do corticosteroids reduce mortality from alcoholic hepatitis? A meta-analysis of the randomized trials",
abstract = "Purpose: To determine whether corticosteroids affect short-term mortality from alcoholic hepatitis. Data Identification: Studies published from 1966 to 1989 were identified through a MEDLINE computer search and an extensive manual search of the bibliographies of identified articles. Study Selection: We found 11 randomized studies (10 of which were placebo controlled) that assessed mortality in hospitalized patients diagnosed with acute alcoholic hepatitis and treated with corticosteroids. Data Extraction: Two critical appraisers independently evaluated trial quality and abstracted quantitative data on clinical characteristics of the populations, interventions, and all-cause mortality. Results of Data Synthesis: Overall, the protective efficacy (or percent reduction in mortality) of corticosteroids was 37{\%} (95{\%} CI, 20{\%} to 50{\%}). Protective efficacy was higher among trials with higher quality scores and trials that excluded subjects with active gastrointestinal bleeding. In subjects with hepatic encephalopathy, protective efficacy was 34{\%} overall (CI, 15{\%} to 48{\%}). It was also higher among trials with higher quality scores and trials excluding subjects with acute gastrointestinal bleeding, but was not present among trials with lower quality scores or trials that did not exclude subjects with acute gastrointestinal bleeding. In subjects without hepatic encephalopathy, corticosteroids had no protective effect, and this lack of efficacy was consistent across all trial subgroups. Conclusions: These results suggest that corticosteroids reduce short-term mortality in patients with acute alcoholic hepatitis who have hepatic encephalopathy, that the protective effect depends on the exclusion criterion of acute gastrointestinal bleeding and is influenced by trial quality, and that corticosteroids are of no benefit in patients without hepatic encephalopathy.",
author = "Imperiale, {T. F.} and McCullough, {A. J.}",
year = "1990",
month = "1",
day = "1",
doi = "10.7326/0003-4819-113-4-299",
language = "English (US)",
volume = "113",
pages = "299--307",
journal = "Annals of Internal Medicine",
issn = "0003-4819",
publisher = "American College of Physicians",
number = "4",

}

TY - JOUR

T1 - Do corticosteroids reduce mortality from alcoholic hepatitis? A meta-analysis of the randomized trials

AU - Imperiale, T. F.

AU - McCullough, A. J.

PY - 1990/1/1

Y1 - 1990/1/1

N2 - Purpose: To determine whether corticosteroids affect short-term mortality from alcoholic hepatitis. Data Identification: Studies published from 1966 to 1989 were identified through a MEDLINE computer search and an extensive manual search of the bibliographies of identified articles. Study Selection: We found 11 randomized studies (10 of which were placebo controlled) that assessed mortality in hospitalized patients diagnosed with acute alcoholic hepatitis and treated with corticosteroids. Data Extraction: Two critical appraisers independently evaluated trial quality and abstracted quantitative data on clinical characteristics of the populations, interventions, and all-cause mortality. Results of Data Synthesis: Overall, the protective efficacy (or percent reduction in mortality) of corticosteroids was 37% (95% CI, 20% to 50%). Protective efficacy was higher among trials with higher quality scores and trials that excluded subjects with active gastrointestinal bleeding. In subjects with hepatic encephalopathy, protective efficacy was 34% overall (CI, 15% to 48%). It was also higher among trials with higher quality scores and trials excluding subjects with acute gastrointestinal bleeding, but was not present among trials with lower quality scores or trials that did not exclude subjects with acute gastrointestinal bleeding. In subjects without hepatic encephalopathy, corticosteroids had no protective effect, and this lack of efficacy was consistent across all trial subgroups. Conclusions: These results suggest that corticosteroids reduce short-term mortality in patients with acute alcoholic hepatitis who have hepatic encephalopathy, that the protective effect depends on the exclusion criterion of acute gastrointestinal bleeding and is influenced by trial quality, and that corticosteroids are of no benefit in patients without hepatic encephalopathy.

AB - Purpose: To determine whether corticosteroids affect short-term mortality from alcoholic hepatitis. Data Identification: Studies published from 1966 to 1989 were identified through a MEDLINE computer search and an extensive manual search of the bibliographies of identified articles. Study Selection: We found 11 randomized studies (10 of which were placebo controlled) that assessed mortality in hospitalized patients diagnosed with acute alcoholic hepatitis and treated with corticosteroids. Data Extraction: Two critical appraisers independently evaluated trial quality and abstracted quantitative data on clinical characteristics of the populations, interventions, and all-cause mortality. Results of Data Synthesis: Overall, the protective efficacy (or percent reduction in mortality) of corticosteroids was 37% (95% CI, 20% to 50%). Protective efficacy was higher among trials with higher quality scores and trials that excluded subjects with active gastrointestinal bleeding. In subjects with hepatic encephalopathy, protective efficacy was 34% overall (CI, 15% to 48%). It was also higher among trials with higher quality scores and trials excluding subjects with acute gastrointestinal bleeding, but was not present among trials with lower quality scores or trials that did not exclude subjects with acute gastrointestinal bleeding. In subjects without hepatic encephalopathy, corticosteroids had no protective effect, and this lack of efficacy was consistent across all trial subgroups. Conclusions: These results suggest that corticosteroids reduce short-term mortality in patients with acute alcoholic hepatitis who have hepatic encephalopathy, that the protective effect depends on the exclusion criterion of acute gastrointestinal bleeding and is influenced by trial quality, and that corticosteroids are of no benefit in patients without hepatic encephalopathy.

UR - http://www.scopus.com/inward/record.url?scp=0025087535&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0025087535&partnerID=8YFLogxK

U2 - 10.7326/0003-4819-113-4-299

DO - 10.7326/0003-4819-113-4-299

M3 - Article

C2 - 2142869

AN - SCOPUS:0025087535

VL - 113

SP - 299

EP - 307

JO - Annals of Internal Medicine

JF - Annals of Internal Medicine

SN - 0003-4819

IS - 4

ER -