Early bilirubin response in acute-on-chronic hepatitis B liver failure patients treated with corticosteroids predicates a lower 3-month mortality

Corticosteroids have been used for acute-on-chronic hepatitis B liver failure (ACHBLF) patients to inhibit overactive immunological responses. Due to the severe side effects of long-term use of corticosteroids, early identification of responders is very important for clinicians. So we conducted this study to identify efficacious indicators for response to corticosteroids. A total of 74 ACHBLF patients treated with corticosteroids were enrolled. Baseline characteristics and change of liver functions at the 3rd, 7th, 10th, 14th, 21th day during the treatment period were analyzed. Data were collected retrospectively and 3-month survival was used as the primary endpoint. 3-month survival in ACHBLF patients treated with corticosteroids was 50.0% ± 5.9%. Survival patients tended to be younger, have lower serum TBIL, creatinine and MELD score, and higher platelet than non-survival patients. After using corticosteroids, there was a significant improvement in TBIL, PTA and MELD score in survival patients compared with non-survival patients. Area under the receiver operating curve (AUROC) indicated that early improvement of bilirubin level (EIBL) at the 7th day after using corticosteroids was an efficacious predictor for response to corticosteroids. Multivariate logistic regression model identified four independent prognostic factors, including age, INR, TBIL, and EIBL, with significantly higher prognostic accuracy than MELD score. Our findings suggest that early improvement of serum bilirubin level at the 7th day after using corticosteroids in ACHBLF patients can predicate responsiveness to corticosteroid therapy and can be use as a favorable prognostic predictor for 3-month mortality in ACHBLF patients treated with corticosteroids.