Case Control Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Aug 27, 2025; 17(8): 108677
Published online Aug 27, 2025. doi: 10.4254/wjh.v17.i8.108677
Patient factors in responders and non-responders treated with steroids for acute alcohol-associated hepatitis
Kent W Sabatose, Alexandra Baker, Kevin Kugler, Jude Delikat, Bethany Jowers, Ambuj Kumar, Sadaf Aslam, Jacentha Buggs, Christine Machado-Denis, Nyingi Kemmer, Kiran Dhanireddy, Rashid Syed
Kent W Sabatose, Lake Erie College of Osteopathic Medicine, Lakewood Ranch, FL 34211, United States
Kent W Sabatose, Nyingi Kemmer, Rashid Syed, Department of Transplant Hepatology, University of South Florida, Tampa General Medical Group, Tampa, FL 33606, United States
Alexandra Baker, Kevin Kugler, University of Tampa, Tampa, FL 33606, United States
Jude Delikat, Bethany Jowers, University of South Florida, Tampa, FL 33620, United States
Ambuj Kumar, Research Methodology and Biostatistics Core, University of South Florida, Tampa, FL 33612, United States
Sadaf Aslam, Department of Infectious Disease, University of South Florida, Tampa, FL 33606, United States
Jacentha Buggs, Recovery Surgeon and Associate Medical Director LifeLink of Florida, University of South Florida, Tampa General Medical Group, Tampa, FL 33606, United States
Christine Machado-Denis, Department of Psychology, Clinical Psychology, University of South Florida, Tampa General Medical Group, Tampa, FL 33606, United States
Kiran Dhanireddy, Department of Hepatobiliary and Pancreatic Surgery, Liver Transplant Surgery, University of South Florida, Tampa, FL 33606, United States
Author contributions: Sabatose KW and Syed R participated in the design and structure of the manuscript; Sabatose KW, Baker A, Kugler K, Delikat J, Jowers B, Kumar A, Aslam S, Buggs J, Machado-Denis C, Kemmer N, Dhanireddy K, and Syed R contributed to the review of the literature, writing and the elaboration of the table; all authors have reviewed the paper.
Institutional review board statement: Institutional review board approval was obtained for this study from the University of South Florida.
Informed consent statement: Institutional review board exempt this study from informed consent requirements.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
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: No additional data are available.
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: Rashid Syed, MD, Department of Transplant Hepatology, University of South Florida, Tampa General Medical Group, 409 Bayshore Blvd, Tampa, FL 33606, United States. rashid.syed@gmail.com
Received: April 20, 2025
Revised: June 11, 2025
Accepted: July 15, 2025
Published online: August 27, 2025
Processing time: 129 Days and 10.2 Hours
Abstract
BACKGROUND

Steroids remain the primary treatment for severe alcohol-associated hepatitis (AAH), though there is little available tools to predict patient response to steroids. It was hypothesized that phosphatidylethanol (PEth) value will inversely correlate with response to steroid therapy based on Lille score in AAH.

AIM

To assess the relationship of patient factors, focusing on pre-steroid therapy PEth value, to steroid therapy response in AAH.

METHODS

A retrospective case control study was performed on patients who received ≥ 4 days of steroid therapy for AAH at our hospital between July 1, 2019 and June 30, 2022. A total of 2087 patients were screened for AAH and those treated with steroids were included for statistical analysis utilizing independent sample t-test and for categorical variables using the χ2 test.

RESULTS

No correlation was found between PEth value, pre-steroids abstinence length, or number of drinks per week pre-steroids and response to steroids. Non-responder status significantly correlated with older age (P = 0.024), lower albumin (P = 0.003), and higher bilirubin (P = 0.010) pre-steroids. Our study suggests that age, pre-steroid albumin, and pre-steroid bilirubin levels may predict nonresponse to steroid therapy. Non-responders have increased incidence of death and higher medical costs.

CONCLUSION

Identifying non-responders through these identified factors should prompt early referral for liver transplantation. Future prospective studies with larger population size are needed to assess the efficacy of combined pre-steroid age, albumin, bilirubin and other biochemical markers as predictors of steroid response.

Keywords: Acute alcohol-associated hepatitis; Steroids; Transplant; Steroid response; Phosphatidylethanol

Core Tip: Steroid therapy for alcohol-associated hepatitis (AAH) remains the primary therapy despite poor predictability of efficacy. Phosphatidylethanol (PEth) value and other biomarkers were analyzed as predictors of steroid therapy response in the treatment of AAH. PEth value was a poor predictor of steroid therapy response, though pre-steroid biochemical markers of liver response to alcohol consumption significantly correlated with steroid response. Identification of non-responders to steroids can direct these patients to earlier enrollment in liver transplantation and avoid unnecessary medical cost.