Beneficial effect of corticosteroids for patients with severe drug‐induced liver injury

Objective The efficacy of corticosteroids in drug‐induced liver injury (DILI) remains controversial. We aimed to determine whether corticosteroids were beneficial for severe DILI. Methods This was a single‐center retrospective study of patients with DILI enrolled between January 2010 and May 2015. Results Of the 203 patients enrolled, 53 were treated with corticosteroids. The baseline characteristics of patients received corticosteroids were more severe than that of the non‐corticosteroid group. Subgroup analyses indicated that almost all patients who died had the higher 50% quartile of total bilirubin (TB) levels. Among the 50–75% quartile of TB level, no patient in the corticosteroids group but 3 (15.0%) of 20 patients in the non‐corticosteroid group died ( P = 0.261). With the highest 25% quartile of TB level, four patients in the corticosteroids group and four in the non‐corticosteroids group died ( P = 0.405). Corticosteroid therapy improved the recovery rate from 77.4% to 87.9% in the higher 50% quartile of TB values ( P = 0.331). More interestingly, corticosteroid administration hastened the resolution of liver injury by shortening the duration of peak TB to 50% reduction from 17 to 12 days ( P < 0.05). Additionally, multivariate analysis revealed that the TB levels and cholestatic injury type were the two independent factors associated with a poor outcome of DILI. Conclusions Corticosteroids are not detrimental to DILI, but instead ameliorate liver injury and improve patient survival. Short‐time use of corticosteroids is strongly recommended for severe DILI patients with hyperbilirubinemia.