LAUSR

Introduction Prednisolone treatment of severe alcoholic hepatitis reduces mortality from 18% to 14% at d28 (STOPAH) but not at d90 (30%). Non-response may be due to steroid-resistance which might be overcome by using intravenous methylprednisolone (MePred). Methods All patient with mDF>32 treated with MePred over a 4 year period were reviewed. Patients were treated with prednisolone 40mg daily for 7 days. Prednisolone non-response was defined as d7 Lille model >0.45 and severe alcoholic hepatitis confirmed by biopsy. Non-responders were given MePred 500mg daily for 3 days followed by prednisolone 40mg daily for 25 days and prophylactic antimicrobials. Results Prednisolone was stopped in 7 non-responders, and MePred was given after biopsy. 5/7 had Lille score 0.45; one failed to respond and died at d9, the other died of liver failure at d28 despite a fall in bilirubin d7-431 to d28-297 (figure 1). No infective complications were reported. Mortality d28 29% and d90 42 %. Conclusions In patients with severe alcoholic hepatitis and prednisolone non-response, methylprednisolone leads to clinical and biochemical response and 58% had at least 90 days survival.