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A Combination of N-Acetylcysteine and Prednisone Has No Benefit Over Prednisone Alone in Severe Alcoholic Hepatitis: A Retrospective Analysis

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Abstract

Introduction

In this study, we assessed whether there were any survival advantages with a combination treatment of intravenous N-acetylcysteine (NAC) and prednisone over prednisone alone in those with severe alcoholic hepatitis [discriminant function (DF) ≥ 32].

Patients and Methods

Between January 1, 2013, and February 28, 2019, we identified 68 patients (mean age 47.2 years ± 10.1, 57% women, 65% cirrhosis, MELD score 28.1 ± 6.6) with alcoholic hepatitis, and of those, 21 (31%) received prednisone and 47 (69%) received prednisone + NAC. Lille score ≥ 0.45 was considered a poor response. Renal insufficiency was defined as GFR < 60 ml/min/1.73m2 calculated on two separate occasions.

Results

DF (74.2 ± 33.6 vs. 56.9 ± 15.9, p = 0.09) was similar, but MELD (29.2 ± 6.3 vs. 25.5 ± 6.4, p = 0.03) scores were higher in the combination group. The overall 30-day and 90-day mortality was 13.2% (9/68) and 20.6% (14/68), respectively. Women were more likely (OR 4.86, 95% CI 1.62–14.59) to respond to treatment based on Lille score compared to men, but the type of treatment regimen had no effect on Lille score (OR 0.84, 95% CI 0.25–2.78). Treatment regimen had no effect on both adjusted and unadjusted survivals. Multivariate analysis, after adjusting for confounding variables, confirmed these observations. DF + renal insufficiency had the highest AUROC (0.86) to predict mortality.

Conclusion

The combination treatment of NAC + prednisone is not better than prednisone alone in patients with severe alcoholic hepatitis.

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Abbreviations

AH:

Alcoholic hepatitis

DF:

Discriminant function

GAHS:

Glasgow alcoholic hepatitis score (GAHS)

MELD:

Model for end-stage liver diseases

NAC:

N-acetylcysteine

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Funding

We received no funding for the study.

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Authors and Affiliations

  1. Institute of Digestive Heath and Liver Diseases, Mercy Medical Center, Baltimore, MD, 21202, USA

    Waseem Amjad, Joseph Alukal, Iliana Doycheva, Talan Zhang, Anurag Maheshwari, Hwan Yoo & Paul J. Thuluvath

  2. Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA

    Anurag Maheshwari & Paul J. Thuluvath

Authors
  1. Waseem Amjad
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  2. Joseph Alukal
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  3. Iliana Doycheva
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  4. Talan Zhang
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  5. Anurag Maheshwari
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  6. Hwan Yoo
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  7. Paul J. Thuluvath
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Contributions

PJT contributed to the conception and design of the study; WA contributed to the acquisition of the data; TZ did statistical analysis; JA, D, AM, HY, WA, and PJT contributed to the drafting of the article; all authors contributed to the analysis, interpretation of the data, and critical revision of important intellectual content; and all authors approved the final version.

Corresponding author

Correspondence to Paul J. Thuluvath.

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The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the IRB (MMC 2019-14). The study was in compliance with all ethical standards, and all investigators have participated in it.

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Informed consent was not applicable as this was a retrospective study.

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Amjad, W., Alukal, J., Doycheva, I. et al. A Combination of N-Acetylcysteine and Prednisone Has No Benefit Over Prednisone Alone in Severe Alcoholic Hepatitis: A Retrospective Analysis. Dig Dis Sci 65, 3726–3733 (2020). https://doi.org/10.1007/s10620-020-06142-4

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