Why Prednisolone for Alcoholic Hepatitis?

Patients presenting with severe alcoholic hepatitis (Discriminant Function value ≥32) have high short-term mortality and may benefit from treatment with glucocorticoids.

Prednisolone is used as oppose to prednisone for 28 days (with taper).

WHY? Prednisone requires conversion to prednisolone (the active metabolite) in the liver. This process may be impaired in alcoholic hepatitis.

REFERENCES

1.  Ramond MJ, Poynard T, Rueff B, Mathurin P, Theodore C, Chaput JC, Benhamou JP. A randomized trial of prednisolone in patients with severe alcoholic hepatitis. N Engl J Med 1992; 326:507. 
2. Friedman SL, McQuaid KR, Grendell JH, et al. Current Diagnosis & Treatment in Gastroenterology, 2nd ed, McGraw-Hill Medical 2002.