Introduction
Alcoholic hepatitis (AH) is frequent among patients addicted to alcohol, with mortality rates of 30-50% in severe cases. The treatment involves alcohol withdrawal, nutritional support, and corticosteroids. However, complications such as upper gastrointestinal bleeding (UGB), infections and acute renal failure (ARF) are common in liver cirrhosis, leading to concern whether corticosteroid usage could worsen these complications. The paucity of prospective studies including such cases make difficult to choose the best treatment in this setting. Therefore, the aim of this study is to appraise the safety of these drugs in severe AH associated with UGB, infections, or ARF, comparing primary outcomes in a sample divided according to the use or not of corticosteroids.

Materials and Methods
The study is retrospective and observational, and the data was collected from medical charts of patients with liver cirrhosis and severe AH, defined by a Maddrey index equal or above 32. They also had at least one of the following complications: UGB, infections, or ARF, and were separated in two groups depending on they received or not corticosteroids. The sample size calculation showed that 70 patients were needed. The statistical analysis was performed on the software SigmaStat, in which Student t test, Mann-Whitney test, qui-square test and Fishers’s exact test were applied to compare the groups.

Results
The sample was composed by 87 patients, of whom 38 were treated with corticoids and 49 received only supportive treatment. The groups did not differ regarding major predictors of poor outcomes, such as the Maddrey index and cirrhosis severity scores. The corticosteroids usage was associated with higher mortality (p= 0.022), longer hospitalization length (p= 0.032) and a higher incidence of hemodynamic shock (p= 0.012).

Conclusions
The results show that corticosteroids should not be given for all AH patients and can be even harmful. Instead, the complications assessed in this study should be carefully sought before prescribing these drugs, tailoring the treatment options for each patient. Corticosteroids should be used only if UGB, infections and ARF are ruled out.