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Severe alcoholic hepatitis (Maddrey's Discriminant Function [MDF] score, >32) can carry risk for 1-month mortality of greater than 50%. Current guidelines recommend corticosteroids for patients with severe acute alcoholic hepatitis, with presumptive benefit for reducing liver inflammation and possible mortality benefit (Hepatology 2010; 51:307). However, not all studies have demonstrated consistent therapeutic benefits for steroids, even in high-risk patients.
In a meta-analysis of 16 randomized clinical trials (>1800 patients with acute alcoholic hepatitis; 90% severe by MDF score) in which systemic corticosteroids (median duration, 1 month) were compared with placebo or no intervention, investigators found no benefit of steroids on 3-month…