The Effect of Single Adminstration of Hydrocortisone in the Treatment of Severe Hyperbilirubinemia in Viral Hepatitis A: A Retrospective Study

Background: Short courses of oral corticosteroids are effective in treating severe hyperbilirubinemia in patients with cholestatic course of viral hepatitis A (VHA). The effect of a single dose of parenteral hydrocortisone has not been described yet.

Methods: We conducted a retrospective study of patients with VHA and severe hyperbilirubinemia (total bilirubin ≥ 200 μmol/l) lasting more than 7 days who received 100 mg of hydrocortisone comparing them to cohort of patient treated by standard symptomatic treatment.

Results: Analysis included data from 46 patients with VHA, 9 of them (19.6%) received a single dose of hydrocortisone (SDH). Times to 25% and 50% decrease of total bilirubin was 4 days (3-5) and 5 days (3-8) in patients that received SDH and 7 days (4-9) and 7 days (9-13) in patients that only received symptomatic treatment. The time difference between both groups was significant for both 25% and 50% decrease of the total bilirubin (p > 0.05). In multivariate regression, SDH administration was negatively associated with time to 25% decrease of total bilirubin (ηp2 = 0.222, 95% CI: -15.687 - -2.944, p > 0.05) and time to 50% decrease of total bilirubin (ηp2 = 0.171, 95% CI: -14.181 - -0.228, p > 0.05) but was not associated with bilirubin concentration at the time of discharge from hospital.

No side effects or complications of hydrocortisone administration were documented.

Conclusions: Administration of SDH was associated with more rapid decrease of plasmatic total bilirubin concentration in patients of VHA with severe hyperbilirubinemia.

Keywords: Viral hepatits A; corticosteroids; hyperbilirubinemia; hydrocortisone.