Glucocorticoid therapy in acute liver failure: Survival outcomes, predictors, and a response prediction model

Table 1 Comparison of responder and nonresponder groups to corticosteroid therapy for acute liver failure, n (%)/median (25^th-75^th percentiles)

Parameters	Overall (n = 84)	Responders group (n = 49)	Nonresponders group (n = 35)	P value
Age	38.00 (26.75-50.00)	37.00 (28.00-49.00)	41.00 (26.00-56.00)	0.57
Gender (male)	43 (51.2)	24 (49.0)	19 (54.3)	0.63
ALT (U/L)	1869.00 (720.78-3601.50)	1379.00 (506.50-3347.00)	2287.00 (810.50-4062.50)	0.12
AST (U/L)	880.00 (289.50-2225.50)	812.00 (216.00-1680.00)	1342.00 (460.00-3178.40)	0.06
TBIL (μmol/L)	255.85 (172.18-346.75)	249.40 (175.90-327.20)	280.20 (170.55-392.95)	0.55
DBIL (μmol/L)	149.40 (90.55-217.50)	137.60 (93.30-212.40)	163.50 (89.10-219.35)	0.73
Albumin (g/L)	32.35 (28.80-34.90)	32.70 (29.40-35.40)	31.60 (27.85-33.30)	0.04
UREA (mmol/L)	4.14 (2.13-6.61)	4.40 (2.13-6.90)	3.74 (2.34-5.70)	0.50
Cr (μmol/L)	62.50 (48.50-108.14)	62.00 (47.00-108.14)	68.00 (49.50-99.50)	0.51
NH3 (ug/dL)	148.00 (110.00-192.25)	133.00 (93.00-172.01)	171.00 (141.50-259.50)	0.00
Na+ (mmol/L)	136.95 (134.65-139.65)	136.70 (134.70-139.10)	137.20 (134.45-139.95)	0.75
K+ (mmol/L)	3.79 (3.58-4.30)	3.73 (3.53-4.22)	3.84 (3.59-4.36)	0.30
PT (second)	42.35 (28.20-70.58)	30.00 (21.60-56.30)	52.20 (40.65, 88.70)	< 0.001
PTA (%)	17.00 (10.75-30.85)	25.00 (13.00-38.80)	15.00 (7.80-18.00)	< 0.001
INR	3.76 (2.43-5.73)	2.88 (1.89-4.98)	4.55 (3.58-7.22)	0.00
FIB (g/L)	1.04 (0.77-1.55)	1.10 (0.80-1.57)	0.98 (0.73-1.37)	0.45
WBC (109/L)	9.57 (7.29-11.80)	9.40 (7.05-11.52)	10.15 (7.60-13.82)	0.35
NEUT (109/L)	6.20 (5.16-9.22)	5.91 (5.06-8.54)	7.52 (5.49, 11.60)	0.12
HGB (g/L)	125.00 (111.00-142.00)	124.00 (113.00-142.00)	126.00 (111.00-145.00)	0.88
PLT (109/L)	150.55 (68.51)	153.04 (65.77)	147.06 (72.99)	0.70
AST/ALT	0.62 (0.33-1.06)	0.60 (0.31-1.03)	0.67 (0.34-1.12)	0.66
NLR	4.84 (2.85-7.96)	4.07 (2.64-7.16)	5.94 (3.88-10.60)	0.04
MEDL	26.50 (20.75-33.00)	23.00 (18.00-28.00)	32.00 (27.00-37.00)	< 0.001
MELD-Na	28.50 (21.75-34.00)	23.00 (19.00-30.00)	34.00 (29.00-37.50)	< 0.001

ALT: Alanine transferase; AST: Aspartate transferase; TBIL: Total bilirubin; DBIL: Direct bilirubin; Cr: Creatinine; PT: Prothrombin time; PTA: Prothrombin activity; INR: International normalized ratio; NH3: Blood ammonia; FIB: Fibrinogen; WBC: White blood cell; NEUT: Neutrophil; NH3: Blood ammonia; HGB: Haemoglobin; PLT: Platelet; NLR: Neutrophil-lymphocyte ratio; MELD: Model for end-stage liver disease.

Table 2 Univariate and multivariate analyses of the efficacy of corticosteroid therapy in patients with acute liver failure

Characteristic	Univariate analysis		Multivariate analysis
	OR (95%CI)	P value	OR (95%CI)	P value
Age	0.84 (0.54-1.29)	0.42	-	-
Gender	1.24 (0.52-2.95)	0.63	-	-
WBC	0.88 (0.57-1.35)	0.55	-	-
NEUT	0.82 (0.53-1.27)	0.37	-	-
HGB	1.20 (0.78-1.85)	0.41	-	-
NLR	0.63 (0.39-1.01)	0.05	-	-
PLT	1.09 (0.70-1.69)	0.69	-	-
ALT	0.68 (0.43-1.08)	0.10	-	-
AST	0.51 (0.24-1.08)	0.08	-	-
AST/ALT	0.96 (0.62-1.48)	0.85	-	-
TBIL	0.86 (0.56-1.33)	0.50	-	-
UREA	0.77 (0.42-1.43)	0.42	-	-
Cr	0.88 (0.57-1.36)	0.58	-	-
INR	0.38 (0.16-0.92)	0.03	1.28 (0.60-2.70)	0.53
PT	0.39 (0.20-0.77)	0.01	0.83 (0.39-1.77)	0.63
PTA	3.24 (1.77-5.94)	< 0.001	4.21 (1.09-16.34)	0.04
ΔPTA	4.96 (2.39-10.33)	< 0.001	7.78 (2.79-21.68)	< 0.001
Blood ammonia	0.46 (0.27-0.79)	0.01	0.42 (0.19-0.96)	0.04

WBC: White blood cell; NEUT: Neutrophil; HGB: Haemoglobin; NLR: Neutrophil-lymphocyte ratio; PLT: Platelet; ALT: Alanine transferase; AST: Aspartate transferase; TBIL: Total bilirubin; UREA: Blood urea; Cr: Creatinine; INR: International normalized ratio; PT: Prothrombin Time; PTA: Prothrombin activity; ΔPTA: Prothrombin activity on day 3-baseline prothrombin activity; NH3: Blood ammonia; OR: Odds ratio.