Prednisolone increases infection in alcoholic hepatitis

Using prednisolone to treat elevating bacterial DNA in patients with alcoholic hepatitis increases the likelihood of developing infection within 7 days of treatment, according to data presented at the British Society of Gastroenterology Annual Meeting.

Stephen R. Atkinson, MBBS, MA, MRCP, clinical research fellow in the department of internal medicine at Imperial College London, U.K., and colleagues extracted DNA from 714 whole blood samples of patients with alcoholic hepatitis recruited to the Steroids or Pentoxifylline for Alcoholic Hepatitis (STOPAH) study, to determine the impact of prednisolone treatment in patients with elevated pre-treatment circulating bacterial DNA (bDNA).

Stephen R. Atkinson

In accordance with the STOPAH study, researchers quantified the DNA then randomly assigned patients to begin treatment with or without prednisolone. The bDNA levels were then compared with various clinical outcomes, including developing infection within 7 days of treatment, static and dynamic markers of liver function and mortality at 28 and 90 days.

Results showed elevated bDNA levels were associated with the development of infection within the first 7 days in patients treated with prednisolone (P = .001). The association between prednisolone and infection remained independent with the subsequent development of infection after multivariate analysis (P = .02).

Patients with high bDNA treated with prednisolone had increased mortality compared with patients with low bDNA (P = .02), indicating that elevated bDNA levels were associated with death at 90 days (P = .05). In addition, patients with elevated bDNA were more likely to die if they were randomly allocated to receive prednisolone (OR = 2.9; 95% CI, 1.2-6.9).

“We estimate that if patients with elevated bDNA were instead treated without prednisolone, 90-day mortality in [alcoholic hepatitis] could be reduced,” the researchers wrote.

The researchers concluded: “Infection is more likely to develop within 7 days if patients with elevated bDNA are treated with prednisolone. Measuring pretreatment bDNA could therefore inform decisions to initiate corticosteroid therapy and has the potential to increase survival at 90 days in [alcoholic hepatitis].” – by Melinda Stevens

References:

Vergis N, et al. Abstract #OC-034. Presented at: British Society of Gastroenterology Annual Meeting; June 20-23, 2016; Liverpool, U.K.

Disclosure: The researchers report no relevant financial disclosures.