Zhang JW. Predicting steroid response in acute alcohol-associated hepatitis: Beyond biomarkers of alcohol consumption. World J Hepatol 2025; 17(10): 112104 [DOI: 10.4254/wjh.v17.i10.112104]
Corresponding Author of This Article
Jin-Wei Zhang, PhD, Professor, State Key Laboratory of Chemical Biology, Shanghai Institute of Organic Chemistry, Chinese Academy of Sciences, No. 345 Lingling Road, Shanghai 200032, China. jinweizhang@sioc.ac.cn
Research Domain of This Article
Medicine, General & Internal
Article-Type of This Article
Letter to the Editor
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. Oct 27, 2025; 17(10): 112104 Published online Oct 27, 2025. doi: 10.4254/wjh.v17.i10.112104
Predicting steroid response in acute alcohol-associated hepatitis: Beyond biomarkers of alcohol consumption
Jin-Wei Zhang
Jin-Wei Zhang, State Key Laboratory of Chemical Biology, Shanghai Institute of Organic Chemistry, Chinese Academy of Sciences, Shanghai 200032, China
Author contributions: Zhang JW designed the overall concept and outline of the manuscript, contributed to the discussion and design of the manuscript, the writing and editing of the manuscript, illustrations, and review of the literature, read and approved the final version of the manuscript to be published.
Supported by National Natural Science Foundation of China, No. 82170406 and No. 81970238.
Conflict-of-interest statement: The author has no conflicts of interest to declare.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jin-Wei Zhang, PhD, Professor, State Key Laboratory of Chemical Biology, Shanghai Institute of Organic Chemistry, Chinese Academy of Sciences, No. 345 Lingling Road, Shanghai 200032, China. jinweizhang@sioc.ac.cn
Received: July 17, 2025 Revised: August 30, 2025 Accepted: September 17, 2025 Published online: October 27, 2025 Processing time: 101 Days and 22.7 Hours
Abstract
Acute alcohol-associated hepatitis (AAH) is a life-threatening condition with high mortality, and steroid therapy remains the mainstay of treatment despite variable efficacy. The study by Sabatose et al explores patient factors distinguishing responders and non-responders to steroid therapy for AAH, focusing on phosphatidylethanol (PEth)-a biomarker of alcohol consumption-and other clinical variables. Their findings indicate that PEth, abstinence duration, and pre-treatment alcohol intake do not predict steroid response, while older age, lower pre-steroid albumin, and higher pre-steroid bilirubin are associated with non-response. Non-responders exhibit higher mortality and healthcare costs, underscoring the need for early identification to guide liver transplantation referrals. This commentary evaluates the implications of these findings-specifically, how prioritizing pre-steroid albumin, bilirubin, and age over alcohol biomarkers can improve clinical decision-making by reducing unnecessary steroid exposure and expediting transplantation referrals for high-risk non-responders-contextualizes them within existing literature, and highlights directions for future research to optimize AAH management.
Core Tip: This manuscript offers a thorough analysis of Sabatose et al's study exploring predictors of steroid response in acute alcohol-associated hepatitis (AAH). The study examines the role of alcohol consumption biomarkers (such as phosphatidylethanol) and clinical factors, revealing that age, pre-steroid albumin, and bilirubin levels-rather than alcohol-related markers-are key predictors of non-response. The identification of poorer outcomes in non-responders, coupled with insights into limitations and future research directions, provides valuable guidance for clinical decision-making and the development of improved strategies for AAH management.
