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Steroid therapy is linked to lower incidence of acute kidney injury in patients with severe alcohol-associated hepatitis
Journal article   Open access   Peer reviewed

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

VTL-308 Study Group, Laura Buttler, Jan Stange, Nikolaos Pyrsopoulos, Tarek Hassanein, Heiner Wedemeyer, Benjamin Maasoumy, Markus Busch and David J Reich
Scientific reports, v 15(1), 43271
08 Dec 2025
DOI: https://doi.org/10.1038/s41598-025-29912-4
PMID: 41354748
url
https://doi.org/10.1038/s41598-025-29912-4View
Published, Version of Record (VoR) Open CC BY V4.0

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.

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