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Glucocorticoid treatment is recommended for patients with severe acute alcoholic hepatitis, but mortality rates are still high, with a 6-month survival rate of only 35%. Now, two French studies examine alternative treatment options.
Nguyen-Khac and colleagues evaluated 6-month survival in 174 patients with severe acute alcoholic hepatitis (defined as a Maddrey's discriminant function score ≥32) who were randomized to receive glucocorticoid therapy with or without N-acetylcysteine (NAC). All patients received 40 mg daily of oral prednisolone for 28 days, and the intervention group also received intravenous infusions of NAC for the first 5 days. Even though 1-month mortality and rates of hepatorenal syndrome were lower in the NAC group than co…