Corticosteroids and Bovine Colostrum in Treatment of Alcoholic Hepatitis ‘In Extremis’: A Pilot Study
2015; Elsevier BV; Volume: 5; Linguagem: Inglês
10.1016/j.jceh.2015.07.037
ISSN2213-3453
AutoresSandeep Singh Sidhu, Omesh Goyal, Ankita Gupta, Harsh Kishore, Akriti Gupta,
Tópico(s)Alcohol Consumption and Health Effects
ResumoBackground and Aims: Severe alcoholic hepatitis, defined by modified Maddrey's discriminant function ≥32, is associated with short-term mortality >30%. Corticosteroids treatment is avoided in these patients due to risk of sepsis. Bovine colostrum has biologic and immune modulatory functions. Bovine colostrum reduces the porto-systemic endotoxemia. We aimed to study the effect of combination therapy of corticosteroids and bovine colostrum in alcoholic hepatitis 'in Extremis" i.e., Maddrey's discriminant function ≥54. Method: Bovine colostrum (20 g thrice in a day for eight weeks) and prednisolone (40 mg once a day for four weeks, tapered over four weeks) were given to patients of alcoholic hepatitis 'in Extremis'. The primary outcome was change of Maddrey's discriminant function from baseline to eight weeks. Paired t test was used to check the significance of change. Results: Ten patients with alcoholic hepatitis "in Extremis" were enrolled in this pilot study. Based on intention to treat population, there was a significant improvement in Maddrey's discriminant function level from 78.1 ± 14.23 to 43.59 ± 23.83 at 8 weeks, mean difference (CI) with respect to baseline [34.714 (21.0–48.43); P = 0.001]. The survival rate at 1 month was 90% (9/10) and 70% (7/10) at 3 months. Conclusion: Combination of prednisolone and bovine colostrum significantly improves the biological function of liver in patients suffering from alcoholic hepatitis "in Extremis". In addition, this combo therapy appears to improve the survival rate in these extremely sick patients.Table 1Test of Difference: Baseline vs 8th Week.Paired differencestp valueMeanStd. deviationStd. error mean95% Confidence interval of the difference95% Confidence interval of the differenceLowerUpperPair 1Bilirubin (baseline)–Bilirubin (8th week)11.8577.7552.9314.68519.0294.045.007PTI (Baseline)–PTI (8th week)4.7142.563.9692.3437.0854.866.003INR Baseline–INR (8th week).143.378.143−.207.4921.000.356Df baseline–DF (8th week)34.71414.8295.60521.00048.4296.194.001 Open table in a new tab
Referência(s)