Short term outcome in severe alcoholic hepatitis patients treated with Methylprednisolone plus N acetylcysteine or Pentoxifylline plus N acetylcysteine

Abstract

Introduction: Severe Alcoholic hepatitis (AH) is an acute form of alcohol induced liver injury. Often it present as fetal diseases with very high (30-50%) short term (28 days) mortality. This study was conducted from period May 2016 to July 2017 in Liver unit, Bir hospital. The main objective was to find out 28 days mortality in patients with severe alcoholic hepatitis who had Discriminant function (DF) ≥ 32. This was a prospective, comparative, randomized interventional hospital based study.

Methodology: Hundred and ten diagnosed patients of severe alcoholic hepatitis who fulfilled the criteria were enrolled and randomized into two groups (odd number and even number). Group 1 received methylprednisolone and group 2 received pentoxifylline for 28 days. In both groups N acetylcysteine were added. Lille score was calculated in methylprednisolone group at day 7 and patients with score of ≤ 0.45 were continued methylprednisolone for total 28 days otherwise stopped. Data were recollected at day 28. They were compared in relation to survival, complications of drugs and causes of mortality.

Results: Mean age of presentation were 40.21±10.5 yrs in methylprednisolone and 42.1±12.1 yrs in pentoxifylline group. In both groups complications were nausea, vomiting, bloating, anorexia and swelling of limb. However, hyperglycemia (16.4%) and renal impairment (9.1%) were more common in methylprednisolone group. Mortality rates were 34.5% in methylprednisolone and 37.8% in pentoxifylline group within 28 days. Common causes of death in both groups were hepatic encephalopathy, hepatorenal syndrome, sepsis or the cause was undetermined.

Conclusion: Alcoholic hepatitis is common manifestation of alcoholic liver disease with high short term mortality in both the groups however adverse effects of drugs are more common in methylprednisolone groups.