Efficacy and safety of glucocorticoid therapy for hepatitis B virus-related liver failure

Objective To assess the clinical efficacy and safety of short-term glucocorticoid therapy in patients with early- or pre-stage hepatitis B virus (HBV)-related liver failure. Methods We retrospectively analyzed 143 patients with early- or pre-stage HBV-related liver failure treated at our center between January 2015 and December 2025. Of these, 43 received methylprednisolone conventional therapy (glucocorticoid group) and 100 received conventional therapy alone (conventional group). We analyzed the trends in total bilirubin (TBil), prothrombin time activity (PTA), and albumin (ALB) between the two groups during the initial 4 weeks, as well as 4-week clinical improvement, 12-week mortality, complications, and HBV-DNA changes. Results The glucocorticoid group showed faster TBil decline and earlier PTA improvement (both P < 0.05). Glucocorticoid group also had significantly higher 4-week clinical improvement (81.4% vs. 54.0%, P = 0.002) and lower 12-week mortality (2.3% vs. 27/0%, P = 0.005). Glucocorticoid therapy was independently associated with 4-week improvement (OR = 4.21) and with a significantly lower risk of death (OR = 0.074). Overall complications were fewer in the glucocorticoid group (37.2% vs. 62.0%, P = 0.006). No significant between-group differences were observed in HBV-DNA levels at baseline or week 4 ( P = 0.389 and P = 0.584, respectively). Conclusion For patients with early or pre-stage HBV-related liver failure, adding short-term methylprednisolone to traditional therapy accelerates the recovery of liver function, improves short-term outcomes, and reduces mortality without a statistically significant increase in complications;no significant increase in HBV-DNA was observed during the 4-week observation period.