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

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.

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Journal
Scientific Reports
Published
2025-12-08
DOI
https://doi.org/10.1038/s41598-025-29912-4
Primary Topic
Alcohol Consumption and Health Effects
Type
article
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article

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

Nikolaos Pyrsopoulos, Benjamin Maasoumy, Tarek Hassanein, Heiner H. Wedemeyer et al.
Scientific Reports
Alcohol Consumption and Health Effects
article

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

Nikolaos Pyrsopoulos, Benjamin Maasoumy, Tarek Hassanein, Heiner H. Wedemeyer, Markus Busch, Laura Buttler, Jan Stange
article en

Abstract

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.

Scientific ReportsVol. 15(1)
Rush University Medical Center (US), University of Minnesota (US), Beth Israel Deaconess Medical Center (US), Cleveland Clinic (US), Montefiore Medical Center (US), University of Miami (US), Johannes Gutenberg University Mainz (DE), Medical University of Graz (AT), University of Applied Sciences Landshut (DE), University of Virginia Health System (US), University of Missouri Hospital (US), Emory University Hospital (US), Piedmont Atlanta Hospital (US), Jefferson Einstein Philadelphia Hospital (US), Hospital General Universitario Gregorio Marañón (ES), Hospital Universitari i Politècnic La Fe (ES), Medizinische Hochschule Hannover (DE), The Bronx Defenders (US), Southern California Reproductive Center (US), University Hospital Münster (DE), Hospital Universitario Puerta de Hierro Majadahonda (ES), Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie (DE), Methodist Hospital (US), Hospital Clínic de Barcelona (ES), German Center for Infection Research (DE), Aurora St. Luke's Medical Center (US), Universitätskliniken Salzburg (AT), University of Pittsburgh Medical Center (US), Hospital Clínico Universitario Lozano Blesa (ES), Universitätsmedizin Rostock (DE), Stanford Medicine (US), Miami Transplant Institute (US), Hospital Universitario Virgen del Rocío (ES), Mercy Medical Center (US), University of Rostock (DE), New York University (US), Drexel University (US), University of Arkansas for Medical Sciences (US), Penn State Milton S. Hershey Medical Center (US), Stanford University (US)
Openalex Percentile: Top 45%
Alcohol Consumption and Health Effects
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