{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T12:16:21Z","timestamp":1789560981665,"version":"build-2803163510"},"reference-count":19,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2015,9,1]],"date-time":"2015-09-01T00:00:00Z","timestamp":1441065600000},"content-version":"tdm","delay-in-days":577,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2014,2]]},"abstract":"<jats:sec>\n                    <jats:title\/>\n                    <jats:p>\n                      <jats:bold>Drug-induced and indeterminate acute liver failure (ALF) might be due to an autoimmune-like hepatitis that is responsive to corticosteroid therapy. The aim of this study was to evaluate whether corticosteroids improve survival in fulminant autoimmune hepatitis, drug-induced, or indeterminate ALF, and whether this benefit varies according to the severity of illness. We conducted a retrospective analysis of autoimmune, indeterminate, and drug-induced ALF patients in the Acute Liver Failure Study Group from 1998\u20132007. The primary endpoints were overall and spontaneous survival (SS, survival without transplant). In all, 361 ALF patients were studied, 66 with autoimmune (25 steroids, 41 no steroids), 164 with indeterminate (21 steroids, 143 no steroids), and 131 with drug-induced (16 steroids, 115 no steroids) ALF. Steroid use was not associated with improved overall survival (61% versus 66%,<\/jats:bold>\n                      <jats:bold>P<\/jats:bold>\n                      <jats:bold>= 0.41), nor with improved survival in any diagnosis category. Steroid use was associated with diminished survival in certain subgroups of patients, including those with the highest quartile of the Model for Endstage Liver Disease (MELD) (&gt;40, survival 30% versus 57%,<\/jats:bold>\n                      <jats:bold>P<\/jats:bold>\n                      <jats:bold>= 0.03). In multivariate analysis controlling for steroid use and diagnosis, age (odds ratio [OR] 1.37 per decade), coma grade (OR 2.02 grade 2, 2.65 grade 3, 5.29 grade 4), MELD (OR 1.07), and pH &lt; 7.4 (OR 3.09) were significantly associated with mortality. Although steroid use was associated with a marginal benefit in SS overall (35% versus 23%,<\/jats:bold>\n                      <jats:bold>P<\/jats:bold>\n                      <jats:bold>= 0.047), this benefit did not persistent in multivariate analysis; mechanical ventilation (OR 0.24), MELD (OR 0.93), and alanine aminotransferase (1.02) were the only significant predictors of SS.<\/jats:bold>\n                      <jats:bold>Conclusion<\/jats:bold>\n                      <jats:bold>: Corticosteroids did not improve overall survival or SS in drug-induced, indeterminate, or autoimmune ALF and were associated with lower survival in patients with the highest MELD scores. (Hepatology 2014;59:612\u2013621)<\/jats:bold>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/hep.26678","type":"journal-article","created":{"date-parts":[[2013,8,8]],"date-time":"2013-08-08T11:21:41Z","timestamp":1375960901000},"page":"612-621","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":172,"title":["Steroid Use in Acute Liver Failure"],"prefix":"10.1097","volume":"59","author":[{"given":"Jamuna","family":"Karkhanis","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth C.","family":"Verna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew S.","family":"Chang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Todd R.","family":"Stravitz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Schilsky","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William M.","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert S.","family":"Brown","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-28-20250207","doi-asserted-by":"crossref","first-page":"1179","DOI":"10.1002\/hep.20703","article-title":"AASLD position paper: the management of acute liver failure.","volume":"41","author":"Polson","year":"2005","journal-title":"Hepatology"},{"key":"R3-28-20250207","doi-asserted-by":"crossref","first-page":"963","DOI":"10.1016\/0140-6736(93)92005-E","article-title":"Autoantibodies to hepatic microsomal carboxylesterase in halothane hepatitis.","volume":"342","author":"Smith","year":"1993","journal-title":"Lancet"},{"key":"R5-28-20250207","first-page":"130","article-title":"A controlled trial of steroid therapy in massive hepatic necrosis.","volume":"62","author":"Ware","year":"1974","journal-title":"Am J Gastroenterol"},{"key":"R6-28-20250207","doi-asserted-by":"crossref","first-page":"620","DOI":"10.1136\/gut.20.7.620","article-title":"Report from the European Association for the Study of the Liver (EASL).","volume":"20","year":"1979","journal-title":"Gut"},{"key":"R7-28-20250207","doi-asserted-by":"crossref","first-page":"1223","DOI":"10.1007\/BF01307513","article-title":"A doubleblinded, randomized trial of hydrocortisone in acute hepatic failure. 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Report of four cases and comparison with autoimmune hepatitis.","volume":"114","author":"Goldstein","year":"2000","journal-title":"Am J Clin Pathol"},{"key":"RU14-28-20250207","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1097\/00004836-200609000-00018","article-title":"Autoimmune hepatitis triggered by statins.","volume":"40","author":"Alla","year":"2006","journal-title":"J Clin Gastroenterol"},{"issue":"Pt 5","key":"RU15-28-20250207","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1258\/0004563054890105","article-title":"Druginduced acute autoimmune hepatitis during combination therapy with atorvastatin and ezetimibe.","volume":"42","author":"Van Heyningen","year":"2005","journal-title":"Ann Clin Biochem"},{"key":"R18-28-20250207","doi-asserted-by":"crossref","first-page":"866","DOI":"10.1016\/S0168-8278(94)80251-3","article-title":"The nature and prognostic implications of autoimmune hepatitis with an acute presentation.","volume":"21","author":"Nikias","year":"1994","journal-title":"J Hepatol"},{"key":"R19-28-20250207","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1016\/S1542-3565(04)00246-0","article-title":"Fulminant hepatic failure as the initial presentation of acute autoimmune hepatitis.","volume":"2","author":"Kessler","year":"2004","journal-title":"Clin Gastroenterol Hepatol"},{"key":"R20-28-20250207","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1002\/lt.500010503","article-title":"Centrilobular necrosis after orthotopic liver transplantation: a longitudinal clinicopathologic study in 71 patients.","volume":"1","author":"Turlin","year":"1995","journal-title":"Liver Transpl Surg"},{"key":"R21-28-20250207","first-page":"1516","article-title":"Overweight patients are more susceptible for acute liver failure.","volume":"52","author":"Canbay","year":"2005","journal-title":"Hepatogastroenterology"},{"key":"R23-28-20250207","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1097\/MOG.0b013e3283528b5d","article-title":"Drug induced liver injury.","volume":"28","author":"Grant","year":"2012","journal-title":"Curr Opin Gastroenterol"},{"key":"R24-28-20250207","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1159\/000322298","article-title":"Steroid and ursodesoxycholic acid combination therapy in severe druginduced liver injury.","volume":"84","author":"Wree","year":"2011","journal-title":"Digestion"}],"container-title":["Hepatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fhep.26678","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.lww.com\/01515467-201402000-00028","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,7]],"date-time":"2025-02-07T11:53:49Z","timestamp":1738929229000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/01515467-201402000-00028"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,2]]},"references-count":19,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2014]]}},"URL":"https:\/\/doi.org\/10.1002\/hep.26678","relation":{},"ISSN":["0270-9139"],"issn-type":[{"value":"0270-9139","type":"print"}],"subject":[],"published":{"date-parts":[[2014,2]]}}}