Summer Gorey, MD
Image source: IU Health
Mortality rates have decreased in patients with severe alcohol-related hepatitis who received corticosteroids after the COVID-19 pandemic, suggesting that infection-mitigating measures may indirectly benefit these individuals.
Dr. Samer Gawrieh, professor of clinical medicine at Indiana University School of Medicine, presented the study this weekend at the American Association for the Study of Liver Diseases (AASLD) 2023 Liver Meeting in Boston, which compared data from five previous and subsequent clinical trials. . During the COVID-19 outbreak.1
“Corticosteroids are the standard treatment for severe alcohol-related hepatitis in the absence of contraindications. The survival benefits of steroids often come at the expense of increased risk of infection,” the researchers wrote.1
Corticosteroids are anti-inflammatory drugs used for a variety of conditions. In addition to reducing inflammation, they can also reduce the production of antibodies, which suppress the immune system. Reduced resistance to infection is a significant side effect of corticosteroids, raising questions about the impact of the COVID-19 pandemic on these more susceptible patients.2
To assess the coincidental impact of infection mitigation measures on mortality in patients with severe alcohol-related hepatitis receiving corticosteroids during the COVID-19 pandemic, researchers collected data from 3 clinical studies conducted before the COVID-19 outbreak, 1 study conducted in the pandemic Clinical studies conducted during the epidemic and 1 time frame before and during COVID-19.1
Researchers define April 1, 2020, as the beginning of the COVID-19 outbreak period because ongoing studies stopped recruiting in the early months of the pandemic. Mortality rates at 28, 90 and 180 days were compared before and during the COVID-19 pandemic in patients receiving corticosteroids. Cox regression analysis was performed to compare survival rates while controlling for patient characteristics.1
Data from a total of 575 patients were examined, 415 from before COVID-19 and 160 from during COVID-19. The researchers noted that patients recruited during the COVID-19 pandemic were younger (43.7 years old, compared with 46.5 years before the epidemic), but the average MELD score was similar (25.7 before the epidemic, 24.8 during the epidemic).1
The researchers noted that mortality rates at 28 days (11.6% vs 2.5%), 90 days (22.4% vs 10%) and 180 days (26.5% vs 15%) were consistently higher in the pre-pandemic period than during the pandemic. high.After controlling for MELD and patient characteristics, the adjusted hazard ratios for 28-day, 90-day, and 180-day survival during COVID were 0.28 (95% confidence interval, 0.1-0.79), 0.51 (95% CI, 0.3-0.87), and 0.57, respectively. (95% CI, 0.36-0.89) (all ask < .05).1
The researchers concluded: “After the COVID-19 outbreak, mortality in patients with SAH who received steroids was significantly reduced, suggesting that infection mitigation measures implemented during the pandemic may benefit patients receiving corticosteroids.”1
refer to:
- Tu W, Nephew LD, Dasarathy S, et al. 169: Mortality reduced in patients with severe alcohol-associated hepatitis (SAH) treated with corticosteroids during the coronavirus pandemic. Paper presented at: Liver Conference. Boston, MA. November 10-14, 2023
- Cleveland Clinic. Corticosteroids. Medications, Devices and Supplements. January 20, 2020. Accessed 13 November 2023. https://my.clevelandclinic.org/health/drugs/4812-corticosteroids