927 PROPOFOL ENHANCES ANTIOXIDANT CAPACITY IN A RAT MODEL OF ACUTE LIVER INJURY INDUCED BY PARACETAMOL INTOXICATION

Background and Aims: To evaluate the benefits and harms of glucocorticosteroids in patients with alcoholic hepatitis.Methods: The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, Science Citation Index Expanded, LILACS and full text searches were conducted.Manufacturers and researchers in the field were contacted.Randomised clinical trials of glucocorticosteroids for patients with alcoholic hepatitis.Data were assessed and extracted by at least two authors independently.The bias risk of the randomised clinical trials was evaluated by methodological components.RevMan Analyses was used for analyses of dichotomous outcomes with relative risks (RR) with 95% confidence intervals (CI).We analysed the data with trial sequential analyses and applied weighted logistic regression analyses using the summarised descriptive data of the treatment and control groups of trials that gave this information.Results: Fifteen trials were included randomising 721 patients.A total of 39.5% died.More than 80% of the trials had high risks of bias and there was evidence of funnel plot asymmetry.Glucocorticosteroids had no statistically significant effect on mortality compared with placebo or no intervention (RR 0.83, 95% CI 0.63 to 1.11).Glucocorticosteroids significantly reduced mortality in the subgroup of trials with low-bias risk (RR 0.33, 95% CI 0.11 to 0.97) and with patients with Maddrey's score of at least 32 or hepatic encephalopathy (RR 0.37, 95% CI 0.16 to 0.86).In all analyses heterogeneity was significant (P < 0.1) and substantial (I2 above 50%).Trial sequential analyses using heterogeneity-corrected information size demonstrated no significant effects of glucocorticosteroids on mortality and that additional large trials are needed.Weighted logistic regression analysis taking prognostic factors at randomisation into consideration found no significant effect on mortality (adjusted RR 0.91, 95% CI 0.60 to 1.36).Glucocorticosteroids significantly increased adverse events (RR 3.63, 95% CI 1.95 to 6.76).Conclusions: Glucocorticosteroids for patients with alcoholic hepatitis can neither be supported nor refuted.Large randomised trials with low risk of bias should be conducted and more beneficial than harmful effects of glucocorticosteroids should be demonstrated before glucocorticosteroids are used in patients with alcoholic hepatitis.