Journal
HEPATOLOGY RESEARCH
Volume 41, Issue 1, Pages 46-53Publisher
WILEY
DOI: 10.1111/j.1872-034X.2010.00740.x
Keywords
acute-on-chronic liver failure; chronic hepatitis B; dexamethasone; pre-liver failure; prognosis
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Funding
- Chinese National Natural Science Foundation [30872229]
- National Science and Technology Support Program [2008BAI52B03]
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Aim: Acute-on-chronic pre-liver failure (pre-ACLF) is defined as a severe acute episode of chronic hepatitis B characterized by serum bilirubin of 171 mu mol/L or more, alanine aminotransferase of five times or more the upper limit of normal and prothrombin activity of more than 40%, having a potential for progression to acute-on-chronic liver failure (ACLF). This study is to evaluate the efficacy of short-term dexamethasone in pre-ACLF. Methods: One hundred and seventy patients were assigned to dexamethasone therapy and control group at a ratio of 1:2. For the two groups, we compared biochemical indicators, the incidence of ACLF and mortality. The influential factors on the mortality of patients with pre-ACLF were studied by Cox proportional hazards models. Results: The significantly lower incidence of ACLF and higher survival rate were observed in patients on dexamethasone therapy (8.9%, 96.4%, respectively) than in control patients (70.2%, 52.6%, respectively; P < 0.001). Dexamethasone treatment was an independent factor influencing the survival rate (P < 0.001, odds ratio = 0.055, 95% confidence interval = 0.013-0.225). During 4 weeks of treatment, serum bilirubin levels of survival patients were significantly lower in the dexamethasone group than control group. Conclusion: Five-day dexamethasone therapy is effective in improving the liver function and survival rate of patients with pre-ACLF.
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