The Beneficial Effect of Corticosteroids for Patients with Severe Drug Induced Liver Injury

Abstract

Background & Aims

The efficacy of corticosteroids in drug-induced liver injury (DILI) remains controversial. Our aim was to determine whether corticosteroids were beneficial for severe DILI.

Methods

This was a single-centre retrospective study of patients with DILI listed January 2010 to May 2015.

Results A total of 203 patients were enrolled and 53 patients treated with corticosteroids. The baseline characteristics of those patients were more severe than that of the no steroids-use group. Subgroup analysis indicated that almost all of the patients died within the higher 50% quartiles of total bilirubin (TB) values. Among the 50% ~ 75% quartiles of TB values, there was none patients died in the steroids-use group, whereas 3 of 20 patients (15%) died in the no steroids-use group (P = 0.261). In the highest 25% quartiles of TB values, 4 of 20 patients died in the steroids use group, whereas 4 of 11 patients died in the no steroids-use group (P = 0.405). Steroids therapy improved the recovery rate from 77.4% to 87.9% in the higher 50% of TB values (P = 0.331). More interestingly, steroids administration hastened the resolution of liver injury by shorten the duration of peak TB to 50% reduction from 17 days to 12 days (P < 0.05). Additionally, multivariate analysis revealed that the TB levels and cholestatic injury type were the two independent factors associated with the poor outcome of DILI.

Conclusions

Corticosteroids are not detrimental to DILI, but instead improve the liver injury and patient survival. Short-time use of corticosteroids is strongly recommended to severe DILI patients with hyperbilirubinemia.

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