Corticosteroid improves liver function but does not curb the clinical progression of hepatitis B virus-related acute-on-chronic pre-liver failure

Background: Hepatitis B virus-related acute-on-chronic pre liver failure (HBV pre-ACLF) has the potential for progression to HBV ACLF. Whether corticosteroid is useful for HBV pre-ACLF remains heterogeneous. This study aimed to evaluate the efficacy of short-term (5 days) and low-dose dexamethasone (5mg/d) toward HBV pre-ACLF.Design and methods: One hundred twenty-one patients with HBV pre-ACLF were randomly divided into two groups: medical comprehensive treatment (MCT) group and corticosteroid treatment (CT) group. Laboratory measurements at admission and 7 days post-admission were compared between the two groups, respectively. Hospitalization periods and clinical progression were also monitored and compared between the two groups.Results: Higher than normal levels of ALT, AST, TBIL, DBIL, TBA and GLO were observed at 7 days after admission in patients in the MCT group than in CT group (p < 0.001).Patients in the CT group had shorter inpatient days than the MCT group (p = 0.002).During hospitalization and treatment, the incidence of HBV ACLF was not substantially different between the two groups (14.8% vs. 8.3%, p = 0.271).Conclusions: Corticosteroid is effective at improving the liver function and decreasing hospitalization periods of patients with HBV pre-ACLF but does not prevent HBV pre-ACLF from progressing to HBVACLF.