SURVIVAL AND PROGNOSTIC FACTORS IN PATIENTS WITH SEVERE ALCOHOLIC HEPATITIS TREATED WITH PREDNISOLONE

Background & Aims: Corticosteroids have been shown to significantly de crease short-term mortality in patients with severe alcoholic hepatiti s, However, independent factors associated with a favorable outcome an d long-term survival are unknown, The aim of this study was to examine prognostic factors and long-term survival in patients with biopsy-pro ven severe alcoholic hepatitis, Methods: Of 183 patients studied, 61 h ad been randomized in a previous trial; 32 of them were treated with p rednisolone (group I) and 29 were not treated (group II); 61 were trea ted from the end of this randomized trial (group III); and 61 were sim ulated (group IV), Results: At 1 year, survival in group 1 (69%; confi dence interval [CI], 57%-81%) and group III (71%; CI, 55%-87%) was bet ter than in the nontreated groups (group II, 41%; CI, 23%-59%; P = 0.0 1) (group IV, 50%; CI, 37%-63%; P = 0.05). At 2 years, survival was no t significantly different. Treated patients with marked liver polymorp honuclear infiltrate had better 1-year survival (76%; CI, 64%-88%) tha n the others (53%; CI, 35%-71%; P = 0.05), Treated patients with polym orphonuclear counts of >5500/mm(3) had better 1-year survival (77%; CI , 65%-89%) than the others (40%; CI, 14%-66%; P = 0.003), In the 93 tr eated patients, liver polymorphonuclear infiltrate (P < 0.03) and poly morphonuclear count (P < 0.001) were independently correlated with 1-y ear survival, Conclusions: Prednisolone reduced mortality by at least 1 year, Liver polymorphonuclear infiltrate and polymorphonuclear count were independent prognostic factors.