Steroid therapy is linked to lower incidence of acute kidney injury in patients with severe alcohol-associated hepatitis
Abstract
Abstract Acute kidney injury (AKI) is a common complication in patients with severe alcohol-associated hepatitis (sAH), yet its risk factors and outcomes remain incompletely defined. Corticosteroids are the only established therapy for sAH, but their impact on renal outcomes is unknown. A post-hoc analysis of the prospective multicenter VTL-308 trial including 151 patients with sAH was conducted to evaluate the incidence and predictors of AKI, the association of corticosteroid therapy with AKI risk, and factors associated with AKI reversal during 90 days of follow-up. AKI was independently associated with significantly higher 90-day mortality (subdistribution hazard ratio (sHR) = 8.74; p < 0.001). In multivariate competing risk analysis, higher bilirubin levels (sHR = 1.06; p = 0.003) were linked to increased AKI risk, while corticosteroids were associated with an ameliorated AKI risk (sHR = 0.47; p = 0.01). Time-censored analyses confirmed the protective association of corticosteroids (HR = 0.25; p = 0.001). Once AKI occurred, corticosteroids did not promote renal recovery (HR = 1.15; p = 0.74). Elevated bilirubin levels were linked to a lower probability of AKI reversal. In conclusion, AKI is a devastating complication in sAH. Corticosteroid therapy is independently associated with a significantly lower risk of AKI development but does not influence recovery once AKI has occurred. Future prospective trials are required to provide further validation of these findings.
Article Details
Authors (38)
Laura Buttler
Heiner Wedemeyer
Benjamin Maasoumy
Jan Stange
David Reich
Lance Stein
Nikolaos Pyrsopoulos
Valentin Cuervas-Mons
Raza Malik
Nikunj Shah
Simona Rossi
Juan Caballeria
Ram Subramanian
Andrés Duarte-Rojo
Julie Thompson
Peter R. Galle
Hartmut H.-J. Schmidt
Markus Busch
Technische Universität Darmstadt, Peter-Gruenberg-Strasse 8, Darmstadt 64289, Germany
Kristina Chacko
Talal Adhami
Constance Mobley
David J. Kramer
Stephen Caldwell
Ali Al-Khafaji
Kalyan R. Bhamidimarri
Manuel Romero-Gomez
Tarek Hassanein
Waldo Concepcion
Martin Prieto Castillo
Rafael Bañares
Syed Naqvi
Matthias Dollinger
Karen Krok
Rudolf Stauber
Christian Zauner
Georg Lamprecht
Paul Thuluvath
Trinidad Serrano Aullo