Dexamethasone in outcome of patients with hepatitis B virus‐related acute‐on‐chronic liver failure

Abstract Background and Aim Acute‐on‐chronic liver failure ( ACLF ) caused by hepatitis B virus ( HBV ) is a severe disease with high mortality. Immune injury plays an important role during the early stage of the disease. Our research aimed to investigate the safety and efficacy of dexamethasone therapy for patients with HBV ‐related ACLF . Methods A total of 134 inpatients with HBV ‐induced ACLF were enrolled from J anuary 2009 to D ecember 2012. All the patients received the standard medicine treatment (SMT), among whom 31 cases underwent additional dexamethasone injection for three times (dexamethasone treatment [DMT] Group). A total of 35 patients ( SMT Group) matched for baseline characters served as controls. Both the groups were followed up for 12 weeks. The survival rates, liver functions, and complications were recorded. Results The 12‐week cumulative survival rates were 45.7% (16/35)and 48.4% (15/31) for SMT G roup and DMT G roup, respectively, and no significant differences were found ( P = 0.959). There were no dramatic differences in liver function and model for end‐stage liver disease ( MELD ) score at 1, 2, 4, 8, and 12 weeks between two groups. There were no significant differences in the incidence of complications (i.e. infection, gastrointestinal bleeding, encephalopathy, hepatorenal syndrome, and ascites) from 1 to 12 weeks between G roup SMT and G roup DMT . More than 40 ages, MELD score more than 28 and encephalopathy were independent risk factors for the mortality of patients. Conclusions Dexamethasone cannot improve liver functions and 12‐week survival rates of patients with HBV ‐related ACLF . Age, MELD score, and encephalopathy are independent risk factors.