Abstract
Liver failure is characterized by serious liver decompensation and high mortality. The activation of systemic immune responses and systemic inflammation are widely accepted as the core pathogenesis of liver failure. Glucocorticoids (GCs) are most regularly utilized to suppress excessive inflammatory reactions and immunological responses. GCs have been used in the clinical treatment of liver failure for nearly 60 years. While there has been no unanimity on the feasibility and application of GC treatment in liver failure until recently. The most recent trials have produced conflicting results when it comes to the dose and time for GC therapy of different etiology of liver failure. Our review outlines the issues and options in managing GC treatment in liver failure based on an investigation of the molecular mechanism that GC may give in the treatment.
Highlights
Liver failure (LF) is a life-threatening syndrome defined as the acute decompensation of liver function with varied etiology and multiple organ dysfunctions [1, 2]
The immunological balance is disrupted in the latter stages of liver failure, resulting in “immune paralysis” and a reduction in the total number and activity of peripheral blood lymphocytes, both of which aided in the progression and exacerbation of LF [28–30]
A prospective multi-center clinical trial totally included 171 Hepatitis B virus (HBV)-acute-on-chronic liver failure (ACLF) patients, 83 patients treated with methylprednisolone [1.5 mg/ kg/day, 1 mg/kg/day, and 0.5 mg/kg/day] for 7 days, the results showed methylprednisolone treatment can increase the 6-month survival rate of HBVACLF patients [27]
Summary
Liver failure (LF) is a life-threatening syndrome defined as the acute decompensation of liver function with varied etiology and multiple organ dysfunctions [1, 2]. Hepatitis B virus (HBV) related acute-on-chronic liver failure (ACLF) is the most common type of end-stage liver disease in chronic HBV infection patients, characterized by rapid deterioration, with muti-organ failure and high short-term mortality [3]. Activation of immune response and systemic inflammation are considered as the key role of LF, glucocorticoids (GCs) have been used in the clinical treatment of LF for many years with the function that can rapidly suppress excessive inflammatory reactions and immune response. This study covers advances on the mechanism, value, existing difficulties, and application tactics of GC application in different etiology LF to identify ideas for further research in related domains and to provide assistance for the clinical management of LF
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