A surreal image representing acute liver failure and the limited effectiveness of certain treatments.

Steroid Treatment for Acute Liver Failure: Does It Really Help?

Theo Raines in Health & Wellness December 2025 • 4 min read.

"A new study sheds light on the effectiveness of steroid treatment for acute-on-chronic liver failure caused by hepatitis B, revealing surprising results."

Researchers have been exploring various medications to manage ACLF, including granulocyte colony-stimulating factor (G-CSF) and erythropoietin (EPO). Corticosteroids, known for their anti-inflammatory properties, have also been considered as a potential treatment, yet their effectiveness remains a subject of debate.

A recent study published in the journal Hepatology investigated the use of steroid treatment in patients with ACLF caused by hepatitis B. The ten-year cohort study, conducted in a university hospital in East China, aimed to determine whether steroids provide a real benefit or if they might even pose unforeseen risks. Here's what they found.

Steroid Treatment: Not a Miracle Cure for Hepatitis B-Related ACLF?

A surreal image representing acute liver failure and the limited effectiveness of certain treatments.

The study followed 293 patients with hepatitis B-precipitated ACLF from 2007 to 2016. Among them, 162 patients received steroid treatment, while the rest served as a control group. The researchers then compared survival rates, clinical characteristics, and infection occurrences between the two groups.

Surprisingly, the study revealed that steroid treatment did not significantly improve non-transplant survival rates. By day 60, the survival rate was 62.6% in the control group versus 53.7% in the steroid group. Further analysis across different subgroups, defined by ACLF grade and MELD score (a measure of liver disease severity), confirmed the lack of survival benefit.

No Improvement in Survival: Steroid treatment failed to show a significant increase in survival rates among ACLF patients caused by hepatitis B.
Increased Infection Risk: Patients treated with steroids experienced a higher frequency of pulmonary and opportunistic infections.
Key Risk Factors Identified: The study identified age, baseline MELD score >20, and CLIF-C ACLF grade 2-3 as independent risk factors for mortality.

The Bottom Line: Rethinking Steroids for ACLF

This research suggests that steroid treatment may not be a beneficial strategy for ACLF patients with hepatitis B and could even increase the risk of infections. The study emphasizes the importance of identifying key risk factors, such as age and disease severity, to better predict patient outcomes.

While steroids might have a role in certain liver conditions, this study urges caution when considering their use in hepatitis B-related ACLF. Further research is needed to explore alternative treatments and preventive strategies that can improve survival rates and quality of life for these patients.

If you or a loved one is dealing with ACLF, it's crucial to discuss these findings with your healthcare provider. Together, you can explore the most appropriate treatment options, taking into account individual risk factors and the latest evidence-based guidelines.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1111/1751-2980.12691, Alternate LINK

Title: Steroid Treatment In Patients With Acute-On-Chronic Liver Failure Precipitated By Hepatitis B: A 10-Year Cohort Study In A University Hospital In East China

Subject: Gastroenterology

Journal: Journal of Digestive Diseases

Publisher: Wiley

Authors: Chong Huang, Kang Kang Yu, Jian Ming Zheng, Ning Li

Published: 2019-01-01

Everything You Need To Know

What is Acute-on-chronic liver failure (ACLF), and why is it important?

Acute-on-chronic liver failure (ACLF) is a severe condition where the liver suddenly deteriorates in individuals with existing chronic liver disease. This can lead to life-threatening complications. While liver transplantation is often the ideal solution, it isn't always accessible or feasible for every patient. The condition is characterized by a rapid decline in liver function in people who already have chronic liver disease. This study focuses on ACLF caused by hepatitis B.

What was the study's focus concerning steroid treatment?

The study investigated steroid treatment in patients with Acute-on-chronic liver failure (ACLF) caused by hepatitis B. Steroids, known for their anti-inflammatory properties, have been considered a potential treatment. The study aimed to determine whether steroids provide a real benefit or if they might even pose unforeseen risks. The study compared survival rates, clinical characteristics, and infection occurrences between the steroid treatment group and a control group.

What were the main results regarding steroid treatment and survival rates?

The primary finding was that steroid treatment did not significantly improve non-transplant survival rates in patients with hepatitis B-related ACLF. The study found that by day 60, the survival rate was actually lower in the steroid group compared to the control group. Further analysis across different subgroups, defined by ACLF grade and MELD score, confirmed the lack of survival benefit. The research showed no improvement in survival with steroids in the context of hepatitis B-related ACLF.

What risks are associated with steroid treatment in the context of this study?

One of the most concerning findings was the increased risk of infections in the steroid-treated group. Pulmonary and opportunistic infections occurred more frequently, suggesting that steroids might weaken the immune system, making patients more vulnerable. This highlights a critical consideration when evaluating the use of steroids in ACLF patients. Steroids, while having anti-inflammatory properties, may also suppress the immune system, making patients more susceptible to infections. This is a significant risk factor when considering steroid treatment for ACLF.

What are the key takeaways and implications of the study's findings?

The study identified key risk factors for mortality, including age, baseline MELD score greater than 20, and CLIF-C ACLF grade 2-3. The research suggests that steroid treatment may not be a beneficial strategy for Acute-on-chronic liver failure (ACLF) patients with hepatitis B and could even increase the risk of infections. The results emphasize the importance of identifying these risk factors to better predict patient outcomes and to consider alternative treatments or interventions.