Therapeutic Role of Early In-Hospital Corticosteroid in Non-A-E Hepatitis

Background and study aim: A debate exists regarding the optimum timing of corticosteroid initiation in acute hepatitis-induced acute liver failure particularly acute non-A-E hepatitis. We aimed to evaluate therapeutic efficacy of early corticosteroid in non-A-E hepatitis. Patients and Methods: In this retrospective study, records of patients in Al-Rajhy Liver University Hospital with acute hepatitis were assessed between 2019-2022. Clinical, laboratory, and mortality data were evaluated for non-A-E hepatitis patients. Liver function and model for end-stage liver disease (MELD) score in corticosteroids group were recorded 1 week after therapy. Results: Sixty-eight patients were categorized into steroid (n=40) and non-steroid (n= 28) groups. Idiopathic hepatitis was common (48.5%) followed by autoimmune hepatitis (19.1%). Mortality in both groups was comparable and the non-survivors significantly suffered liver failure, high hepatic encephalopathy (HE) grade, and MELD. Early corticosteroids (< 7 days of hospital admission) were prescribed to 22 patients and for 18 in late corticosteroids. Higher MELD was significant in non-survivors of early steroids group (p= 0.021). Improvement in liver function was reported in early and late steroids groups but not significantly for albumin, INR or MELD. Mortality in early steroid occurred in 40.9%, and in 33.3% of late steroid. Higher HE grades (OR: 29.267), etiology of hepatitis (OR: 4.272), and albumin (OR: 0.818) were predictors of mortality. Conclusion: Early corticosteroids in non-A-E hepatitis did not significantly improve the severity of hepatitis or the mortality. Careful assessment of etiology of hepatitis and severity of liver disease should be performed before initiating corticosteroid to consider early liver transplantation.