He YL, Yin XH, Xu XT, Li J, Meng QH. Glucocorticoid therapy in acute liver failure: Survival outcomes, predictors, and a response prediction model. World J Hepatol 2026; 18(4): 117905 [DOI: 10.4254/wjh.v18.i4.117905]
Corresponding Author of This Article
Qing-Hua Meng, Professor, Interventional Therapy Center for Oncology, Beijing YouAn Hospital, Capital Medical University, No. 8 Xitou Tiao, Fengtai District, Beijing 100069, China. meng_qh0805@ccmu.edu.cn
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
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. Apr 27, 2026; 18(4): 117905 Published online Apr 27, 2026. doi: 10.4254/wjh.v18.i4.117905
Glucocorticoid therapy in acute liver failure: Survival outcomes, predictors, and a response prediction model
Yu-Lan He, Xue-Hong Yin, Xiao-Tong Xu, Juan Li, Qing-Hua Meng
Yu-Lan He, Qing-Hua Meng, Interventional Therapy Center for Oncology, Beijing YouAn Hospital, Capital Medical University, Beijing 100069, China
Xue-Hong Yin, Surgical Intensive Care Unit, Beijing Shijitan Hospital, Capital Medical University, Beijing 100069, China
Xiao-Tong Xu, The Second Department of Hepatology, Beijing YouAn Hospital, Capital Medical University, Beijing 100069, China
Juan Li, Department of Clinical Oncology, Beijing YouAn Hospital, Capital Medical University, Beijing 100069, China
Co-first authors: Yu-Lan He and Xue-Hong Yin.
Author contributions: Meng QH was responsible for research conception and design; He YL was responsible for data collection and follow-up; Xu XT and Yin XH were responsible for data analysis; He YL and Xu XT were responsible for drafting the manuscript; Li J and Meng QH were responsible for reviewing and revising the manuscript; He YL and Yin XH have made crucial and indispensable contributions towards the completion of the project and thus qualified as the co-first authors of the paper.
Institutional review board statement: This study/project was approved by the Ethics Committee of Beijing YouAn Hospital, Capital Medical University (No. LL-2024-139-K).
Informed consent statement: The informed consent form was waived by the ethics committee.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement- checklist of items.
Data sharing statement: The authors confirm that the data supporting the findings of this study are available within the article and its Supplementary materials.
Corresponding author: Qing-Hua Meng, Professor, Interventional Therapy Center for Oncology, Beijing YouAn Hospital, Capital Medical University, No. 8 Xitou Tiao, Fengtai District, Beijing 100069, China. meng_qh0805@ccmu.edu.cn
Received: December 22, 2025 Revised: January 27, 2026 Accepted: March 23, 2026 Published online: April 27, 2026 Processing time: 123 Days and 17.7 Hours
Abstract
BACKGROUND
Glucocorticoids (GC) are a potential therapy for acute liver failure (ALF). However, their clinical efficacy remains controversial, with significant interpatient heterogeneity.
AIM
To assess the impact of GC therapy on 28-day survival of patients with ALF and identify early treatment-response factors.
METHODS
In this single-centre retrospective cohort study, 179 patients with ALF from the past 12 years were included: 84 received GC treatment, and 95 served as non-GC controls. The primary outcome was 28-day survival. GC-treated patients were further stratified into responders and nonresponders to analyse the determinants of efficacy. Survival distributions were compared using Kaplan-Meier curves with the log-rank test. Independent predictors of GC response were identified through multivariate logistic regression. Statistical significance was set at P < 0.05.
RESULTS
The 28-day survival rate was significantly greater in the GC group than in the control group (58.3% vs 30.5%, P < 0.001). An early increase in prothrombin activity (PTA ≥ 4.5% by day 3), along with baseline model for end-stage liver disease (MELD) score < 28.5 and blood ammonia concentration < 135.5 μg/dL, was independently associated with GC response. A model combining these factors predicted GC responsiveness with an accuracy of 95.2%.
CONCLUSION
GC therapy improves 28-day ALF survival. An early increase in the PTA, combined with baseline MELD score and blood ammonia level, effectively identifies patients who are most likely to benefit.
Core Tip: This retrospective cohort study of 179 acute liver failure patients demonstrates that glucocorticoid (GC) therapy significantly improves 28-day survival (58.3% vs 30.5%, P < 0.001). An early increase in prothrombin activity ≥ 4.5% by day 3, alongside baseline model for end-stage liver disease score < 28.5 and blood ammonia < 135.5 μg/dL, forms a highly accurate predictive model for GC response (95.2% accuracy). This model provides a practical tool to select patients most likely to benefit from GC treatment.
