Patient factors in responders and non-responders treated with steroids for acute alcohol-associated hepatitis

Steroids remain the primary treatment for severe alcohol-associated hepatitis (AAH), though there is little available tools to predict patient response to steroids. It was hypothesized that phosphatidylethanol (PEth) value will inversely correlate with response to steroid therapy based on Lille score in AAH.

To assess the relationship of patient factors, focusing on pre-steroid therapy PEth value, to steroid therapy response in AAH.

A retrospective case control study was performed on patients who received ≥ 4 days of steroid therapy for AAH at our hospital between July 1, 2019 and June 30, 2022. A total of 2087 patients were screened for AAH and those treated with steroids were included for statistical analysis utilizing independent sample t-test and for categorical variables using the χ ² test.

No correlation was found between PEth value, pre-steroids abstinence length, or number of drinks per week pre-steroids and response to steroids. Non-responder status significantly correlated with older age (P = 0.024), lower albumin (P = 0.003), and higher bilirubin (P = 0.010) pre-steroids. Our study suggests that age, pre-steroid albumin, and pre-steroid bilirubin levels may predict nonresponse to steroid therapy. Non-responders have increased incidence of death and higher medical costs.

Identifying non-responders through these identified factors should prompt early referral for liver transplantation. Future prospective studies with larger population size are needed to assess the efficacy of combined pre-steroid age, albumin, bilirubin and other biochemical markers as predictors of steroid response.