{
  "abstract": "Introduction Prednisolone (Pred) treatment of severe alcoholic hepatitis reduces mortality from 18% to 14% at d28 (STOPAH) but not at d90 (30%). Lille model < 0.45 at d7 identifies a poor outcome (180d mortality 75%) and treatment cessation should be considered to avoid harm. We investigated whether initial steroid non-response could be overcome by using intravenous methylprednisolone (MePred).Methods Patients with mDF>32 and GAHS>8 treated with MePred were identified from pharmacy records. Patients presenting with severe alcoholic hepatitis were screened for sepsis, nutritionally optimised, and treated for any AKI or GI bleed if present before commencement of Pred. All patients were initially treated with Pred 40mg daily for 7 days. Non-response defined as d7 Lille model >0.45 led to Pred discontinuation, and severe alcoholic hepatitis was confirmed by urgent biopsy. Biopsy evidence of alcoholic hepatitis triggered treatment with MePred 500mg daily for 3 days followed by Pred 40–60mg daily for 25 days and prophylactic antimicrobials for 28dResults Between (2015–2025), we identified 17 patients (MELD score:median 29[26–32]) treated with MePred following Pred non-response. 15/17 had liver biopsy which confirmed alcoholic hepatitis whilst 2 did not undergo biopsy. Between D0–7 of starting MePred two patients died, and another 7 patients died between D7–28 due to progressive liver failure. At D7 post MePred, 9/17 had Lille score < 0.45 of whom 7 patients survived beyond 180d ( figure 1). No infective complications were reported. Mortality in this group was 52% (d28) and 59%(d180).Abstract P20 Figure 1Bilirubin changes with treatment, blue: survivors, red: diedConclusion In patients with severe alcoholic hepatitis and prednisolone non-response, methylprednisolone leads to clinical and biochemical response with 41% survival at 180 days compared to 25% survival predicted by the Lille model. Further studies are needed to clarify the potential role of steroid dose escalation in severe alcoholic hepatitis",
  "authors": [
    {
      "affiliations": [
        "Royal Derby Hospital, UK"
      ],
      "name": "Mohamed Elnagar"
    },
    {
      "affiliations": [
        "Royal Derby Hospital, UK"
      ],
      "name": "Tiffany Upton"
    },
    {
      "affiliations": [
        "Royal Derby Hospital, UK"
      ],
      "name": "Claire Grant"
    },
    {
      "affiliations": [
        "Royal Derby Hospital, UK"
      ],
      "name": "Adam Lawson"
    },
    {
      "affiliations": [
        "Royal Derby Hospital, UK"
      ],
      "name": "Nick Taylor"
    },
    {
      "affiliations": [
        "Royal Derby Hospital, UK"
      ],
      "name": "Andrew Austin"
    }
  ],
  "title": "P20 Methylprednisolone in the treatment of severe alcoholic hepatitis not responding to standard corticosteroid therapy",
  "uid": "3690e57b-f334-5362-a503-5db38867e342"
}