Clinical and translational gastroenterology · 2026
Optimal Corticosteroid Use in Patients With Severe Alcohol-Associated Hepatitis: A Systematic Review and Meta-Analysis.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Elmustafa Fatima, Sideeg Abdelhaleem, Tyagi Mahima, Bhagavathula Akshaya Srikanth, Pagadala Mangesh, Arab Juan P, Singal Ashwani K
Аннотация
BACKGROUND: The Lille score is an established tool to guide corticosteroid (CS) response and treatment in severe alcohol-associated hepatitis (AH), MELD score >20. However, its use in clinical trials has remained inconsistent. We performed this meta-analysis to compare mortality and infection rates between studies using Lille-guided versus those using CS not guided by the Lille score.
METHODS: We performed a systematic review and meta-analysis of randomized controlled trials (2007-2025) evaluating treatment arms using CS in severe AH. Pooled mortality and infection rates at 28, 90, and 180 days were calculated for Lille-guided and non-Lille-guided arms.
RESULTS: Fourteen corticosteroid-treated arms from 13 trials (N=1,294) were included, of which four studies (n=437) used CS guided by the Lille score. Mortality was lower in Lille-guided arms compared with non-Lille-guided arms at 28 days: [8 (2-14) vs 21 (13-29)] %, P=0.01, and at 90 days [15 (10-20) vs 40 (25-56)] %, P<0.001, but similar at 180 days [35 (16-54) vs 48 (34-62)] %, P=0.27. Infection rates at corresponding time points were 14 (11-17), 26 (14-38), and 32 (19-44), without differences between Lille- and non-Lille-guided CS arms. Substantial heterogeneity existed across studies, mainly due to differences in the publication year of the 28-day mortality outcome.
CONCLUSION: Lille-guided CS use is associated with lower mortality across follow-up periods without a significant difference in infection rates. These findings support the use of the Lille score to guide CS therapy in patients with severe AH.
METHODS: We performed a systematic review and meta-analysis of randomized controlled trials (2007-2025) evaluating treatment arms using CS in severe AH. Pooled mortality and infection rates at 28, 90, and 180 days were calculated for Lille-guided and non-Lille-guided arms.
RESULTS: Fourteen corticosteroid-treated arms from 13 trials (N=1,294) were included, of which four studies (n=437) used CS guided by the Lille score. Mortality was lower in Lille-guided arms compared with non-Lille-guided arms at 28 days: [8 (2-14) vs 21 (13-29)] %, P=0.01, and at 90 days [15 (10-20) vs 40 (25-56)] %, P<0.001, but similar at 180 days [35 (16-54) vs 48 (34-62)] %, P=0.27. Infection rates at corresponding time points were 14 (11-17), 26 (14-38), and 32 (19-44), without differences between Lille- and non-Lille-guided CS arms. Substantial heterogeneity existed across studies, mainly due to differences in the publication year of the 28-day mortality outcome.
CONCLUSION: Lille-guided CS use is associated with lower mortality across follow-up periods without a significant difference in infection rates. These findings support the use of the Lille score to guide CS therapy in patients with severe AH.