Infections are common in patients with severe alcoholic hepatitis (SAH). Vergis et al. highlight how prednisolone could increase susceptibility to infection, which would offset its therapeutic benefit. Of 1,092 patients with SAH included in a controlled trial of prednisolone (40 mg daily) versus pentoxifylline (400 mg 3 times each day), 251 developed infections during and 89 developed infections after treatment. No association was observed between pentoxifylline and risk of serious infection, but serious infections were more frequent in patients treated with prednisolone and a higher proportion of patients receiving prednisolone developed an infection after treatment than those not receiving prednisolone (10% versus 6%). Infection was also associated with an increased 90-day mortality in patients with SAH treated with prednisolone. Finally, high levels of circulating bacterial DNA predicted infection that developed within 7 days of prednisolone therapy.
Vergis, N. et al. Patients with severe alcoholic hepatitis given prednisolone therapy who have high circulating levels of bacterial DNA are at increased risk of developing infections. Gastroenterology http://dx.doi.org/10.1053/j.gastro.2016.12.019 (2017)
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Ray, K. Alcoholic hepatitis: a warning for prednisolone and infection risk?. Nat Rev Gastroenterol Hepatol 14, 68 (2017). https://doi.org/10.1038/nrgastro.2017.5