In people with relatively modest underlying chronic liver disease, recent high alcohol use can cause severe alcohol-associated hepatitis, a fast developing inflammatory liver disease. Globally, its prevalence is increasing, especially among women and younger people. The 90-day mortality rate for AH is still high, ranging from 23 to 29%, despite intensive treatment, and complications including AKI become important predictors of prognosis.
AKI is a common occurrence in liver disease patients and a significant clinical problem in the treatment of acute-on-chronic liver failure (ACLF) and decompensated cirrhosis (DC). The pathogenesis of AKI in this scenario may be very different from other types of liver-related kidney damage since sAH is characterized by severe systemic inflammation and may develop independently of cirrhosis.
The objectives of this study were to: (i) ascertain the incidence and mortality of AKI; (ii) look into predictors of AKI development; (iii) assess the effect of corticosteroid treatment on AKI risk; and (iv) find parameters linked to AKI reversal in a clearly defined cohort of patients with sAH.
To assess the incidence and predictors of AKI, the relationship between corticosteroid medication and AKI risk, and the variables linked to AKI reversal over a 90-day follow-up period, a post-hoc analysis of the prospective multicenter VTL-308 study comprising 151 patients with sAH was carried out.
Significantly greater 90-day mortality was independently linked to AKI (subdistribution hazard ratio (sHR) = 8.74; p < 0.001). Also, greater bilirubin levels (sHR = 1.06; p = 0.003) were related with a greater risk of AKI in multivariate competing risk analysis, whereas corticosteroids were connected to a lower risk of AKI (sHR = 0.47; p = 0.01).
The preventive effect of corticosteroids was validated by time-censored analyses (HR = 0.25; p = 0.001). Corticosteroids did not aid in renal recovery after AKI (HR = 1.15; p = 0.74). A decreased likelihood of AKI reversal was associated with elevated bilirubin levels. To sum up, AKI is a terrible consequence of sAH.
Overall, it is crucial to manage problems in people with liver diseases. This research revealed a continuous protective relationship between corticosteroid medication and AKI, which may have therapeutic implications for this susceptible group.
Source:
Buttler, L., Stange, J., Pyrsopoulos, N., Hassanein, T., Wedemeyer, H., Maasoumy, B., Busch, M., & VTL-308 study group. (2025). Steroid therapy is linked to lower incidence of acute kidney injury in patients with severe alcohol-associated hepatitis. Scientific Reports, 15(1), 43271. https://doi.org/10.1038/s41598-025-29912-4
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