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<p>Acute kidney injury (AKI) is a common complication in patients with severe alcohol-associated hepatitis (sAH), yet its risk factors and outcomes remain incompletely defined. Corticosteroids are the only established therapy for sAH, but their impact on renal outcomes is unknown. A post-hoc analysis of the prospective multicenter VTL-308 trial including 151 patients with sAH was conducted to evaluate the incidence and predictors of AKI, the association of corticosteroid therapy with AKI risk, and factors associated with AKI reversal during 90&#xa0;days of follow-up. AKI was independently associated with significantly higher 90-day mortality (subdistribution hazard ratio (sHR) = 8.74; p &lt; 0.001). In multivariate competing risk analysis, higher bilirubin levels (sHR = 1.06; p = 0.003) were linked to increased AKI risk, while corticosteroids were associated with an ameliorated AKI risk (sHR = 0.47; p = 0.01). Time-censored analyses confirmed the protective association of corticosteroids (HR = 0.25; p = 0.001). Once AKI occurred, corticosteroids did not promote renal recovery (HR = 1.15; p = 0.74). Elevated bilirubin levels were linked to a lower probability of AKI reversal. In conclusion, AKI is a devastating complication in sAH. Corticosteroid therapy is independently associated with a significantly lower risk of AKI development but does not influence recovery once AKI has occurred. Future prospective trials are required to provide further validation of these findings.</p>

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Steroid therapy is linked to lower incidence of acute kidney injury in patients with severe alcohol-associated hepatitis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月8日

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  • Laura Buttler,
  • Jan Stange,
  • Nikolaos Pyrsopoulos,
  • Tarek Hassanein,
  • Heiner Wedemeyer,
  • Benjamin Maasoumy,
  • Markus Busch,
  • Jan Stange,
  • David Reich,
  • Lance Stein,
  • Nikolaos Pyrsopoulos,
  • Valentin Cuervas-Mons,
  • Raza Malik,
  • Nikunj Shah,
  • Simona Rossi,
  • Juan Caballeria,
  • Ram Subramanian,
  • Andres Duarte-Rojo,
  • Julie Thompson,
  • Peter R. Galle,
  • Hartmut H.-J. Schmidt,
  • Markus Busch,
  • Kristina Chacko,
  • Talal Adhami,
  • Constance Mobley,
  • David J. Kramer,
  • Stephen Caldwell,
  • Ali Al-Khafaji,
  • Kalyan R. Bhamidimarri,
  • Manuel Romero-Gomez,
  • Tarek Hassanein,
  • Waldo Concepcion,
  • Martin Prieto Castillo,
  • Rafael Bañares,
  • Syed Naqvi,
  • Matthias Dollinger,
  • Karen Krok,
  • Rudolf Stauber,
  • Christian Zauner,
  • Georg Lamprecht,
  • Paul Thuluvath,
  • Trinidad Serrano Aullo

摘要

Acute kidney injury (AKI) is a common complication in patients with severe alcohol-associated hepatitis (sAH), yet its risk factors and outcomes remain incompletely defined. Corticosteroids are the only established therapy for sAH, but their impact on renal outcomes is unknown. A post-hoc analysis of the prospective multicenter VTL-308 trial including 151 patients with sAH was conducted to evaluate the incidence and predictors of AKI, the association of corticosteroid therapy with AKI risk, and factors associated with AKI reversal during 90 days of follow-up. AKI was independently associated with significantly higher 90-day mortality (subdistribution hazard ratio (sHR) = 8.74; p < 0.001). In multivariate competing risk analysis, higher bilirubin levels (sHR = 1.06; p = 0.003) were linked to increased AKI risk, while corticosteroids were associated with an ameliorated AKI risk (sHR = 0.47; p = 0.01). Time-censored analyses confirmed the protective association of corticosteroids (HR = 0.25; p = 0.001). Once AKI occurred, corticosteroids did not promote renal recovery (HR = 1.15; p = 0.74). Elevated bilirubin levels were linked to a lower probability of AKI reversal. In conclusion, AKI is a devastating complication in sAH. Corticosteroid therapy is independently associated with a significantly lower risk of AKI development but does not influence recovery once AKI has occurred. Future prospective trials are required to provide further validation of these findings.