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Predictors of steroid non-response and new approaches in severe alcoholic hepatitis

Clinical and Molecular Hepatology 2020년 26권 4호 p.639 ~ 651
Sarin Shiv Kumar, Sharma Shvetank,
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 ( Sarin Shiv Kumar ) - Institute of Liver and Biliary Sciences Department of Hepatology and Liver Transplantation
 ( Sharma Shvetank ) - Institute of Liver and Biliary Sciences Department of Molecular and Cellular Medicine

Abstract


Severe alcoholic hepatitis (SAH) remains a disease with high mortality. Steroid is the main stay and has been shown to give modest 28-day survival benefit in carefully selected patients, but no 90-day survival benefit. Since non-responders have high incidence of infections and increased mortality, it would be worthwhile to identify them before starting steroid therapy. A high and rising bilirubin, urinary acetyl carnitine >2,500 ng/mL, high asiloglycoprotein positive microparticles, and specific features in liver biopsy could predict steroid non-response at baseline. There is an ever-growing need to find new and effective therapies for SAH patients. Besides aggressive nutrition, granulocyte colony stimulating factor, fecal microbiota transplantation, and plasma exchange appear promising therapies and provide a hope for steroid ineligible or steroid non-responsive patients. Suppression of hepatic inflammation, preventing new bacterial or fungal infections, and enhancing liver regeneration will remain the key targets for next generation therapies.

키워드

Hepatitis, Alcoholic; Steroids; Granulocyte colony-stimulating factor; Microbiota; Microvesicles

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