***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective : The objective of this work was to develop practice guidelines for the management of  alcoholic liver disease .  Method : A computerized search using the Medline Data Base from 1966–July 1997 was performed with the search headings ; alcohol , alcoholic hepatitis , alcoholic liver disease , liver transplant , diagnosis , epidemiology , human , and English only . All r and omized controlled trials , case-control studies , and meta-analyses were read in depth . A manual search was also done using references from each retrieved report , review articles , editorials , postgraduate course syllabi , and textbooks . In the subsequent review , evidence was evaluated using a hierarchical scale with r and omized , controlled trials given the most importance . Abstract s presented at national meetings were included only when unique data were obtained from those studies The efficacy of methylprednisolone ( 1 g daily or three days ) , which is effective in reversing transplant rejection , was assessed in a r and omised controlled trial of 55 patients with severe acute alcoholic hepatitis , 34 of whom had encephalopathy . The clinical progress , frequency of bleeding and sepsis , and cause of death were similar in the treatment ( 27 patients ) and control groups ( 28 patients ) . There was no significant difference in mortality rate between the two groups : 57 % of the control group and 63 % of the treatment group died during the study . Patients ' survival depended on the presence of absence of the following features : encephalopathy , serum bilirubin concentration more than 340 micromol/l , serum creatinine concentration more than 250 micromol/l , and histological evidence of cirrhosis as well as severe acute alcoholic hepatitis STUDY OBJECTIVE To determine the efficacy of a corticosteroid in reducing the short-term mortality of patients with severe alcoholic hepatitis . DESIGN R and omized , double-blind , placebo-controlled multicenter trial . SETTING Four university teaching hospitals . PATIENTS We enrolled 66 patients with alcoholic hepatitis and either spontaneous hepatic encephalopathy or a discriminant function value greater than 32 , calculated using the formula : 4.6 ( prothrombin time - control time ) + serum bilirubin [ in mumol/L]/17.1 . Fifty-nine patients ( 89 % ) completed the study . Two patients withdrew from the trial . The other 64 patients were hospitalized for the duration of the trial ; however , treatment was discontinued in 5 patients because of potential drug toxicity . INTERVENTIONS Patients were r and omly assigned to receive either methylprednisolone ( 32 mg ) or placebo within 7 days of admission . Treatment was given for 28 days . The doses were then tapered over 2 weeks and discontinued . MEASUREMENTS AND MAIN RESULTS The endpoint of the study was death . Of the 31 recipients of placebo , 11 ( 35 % ) died within 28 days of r and omization compared with 2 ( 6 % ) of the 35 patients given methylprednisolone ( P = 0.006 ) . The 95 % CI for the difference in mortality was 12 % to 70 % . In the patients with spontaneous hepatic encephalopathy at entry , 9 of 19 recipients of placebo  died ( 47 % ) compared with 1 ( 7 % ) of the 14 patients given methylprednisolone ( P = 0.02 ) . The 95 % CI for the difference in mortality was 14 % to 66 % . The Cox proportional hazards regression model showed the advantage of methylprednisolone over placebo after adjustment for other potentially important prognostic variables ( P = 0.004 ) . CONCLUSIONS Methylprednisolone therapy decreases short-term mortality in patients with severe alcoholic hepatitis manifested either by spontaneous hepatic encephalopathy or a markedly elevated discriminant function value In a prospect i ve double-blind study , 27 patients with alcoholic hepatitis were r and omized for 6-methylprednisolone ( 12 patients ) or placebo treatment ( 15 patients ) . The mortality was 50 % among steroid treated patients and 47 % in the control group ( P less than .05 ) . The role of liver biopsy feasibility at selection is emphasized since the mortality in this group was 10 % as opposed to 71 % when the procedure was contraindicated ( P less than .01 ) . Complications in the steroid-treated subjects were similar quantitatively and qualitatively to those observed in the control series Steroids are recommended in severe alcohol-induced hepatitis , but some data suggest that artificial nutrition could also be effective . We conducted a r and omized trial comparing the short- and long-term effects of total enteral nutrition or steroids in these patients . A total of 71 patients ( 80 % cirrhotic ) were r and omized to receive 40 mg/d prednisolone ( n = 36 ) or enteral tube feeding ( 2,000 kcal/d ) for 28 days ( n = 35 ) , and were followed for 1 year or until death . Side effects of treatment occurred in 5 patients on steroids and 10 on enteral nutrition ( not significant ) . Eight enterally fed patients were prematurely withdrawn from the trial . Mortality during treatment was similar in both groups ( 9 of 36 vs. 11 of 35 , intention-to-treat ) but occurred earlier with enteral feeding ( median 7 vs. 23 days ; P = .025 ) . Mortality during follow-up was higher with steroids ( 10 of 27 vs. 2 of 24 intention-to-treat ; P = . 04 ) . Seven steroid patients died within the first 1.5 months of follow-up . In contrast to total enteral nutrition ( TEN ) , infections accounted for 9 of 10 follow-up deaths in the steroid group . In conclusion , enteral feeding does not seem to be worse than steroids in the short-term treatment of severe alcohol-induced hepatitis , although death occurs earlier with enteral nutrition . However , steroid therapy is associated with a higher mortality rate in the immediate weeks after treatment , mainly because of infections . A possible synergistic effect of both treatments should be investigated Abstract A prospect i ve , double-blind controlled pilot study in 20 subjects of the efficacy of glucocorticosteroids in the treatment of severe , life-threatening , alcoholic hepatitis failed to demons A cooperative study was conducted to determine the efficacy of 30 days of treatment with either a glucocorticosteroid ( prednisolone ) or an anabolic steroid ( ox and rolone ) in moderate or severe alcoholic hepatitis . One hundred thirty-two patients with moderate disease and 131 with severe disease were r and omly assigned to one of three treatments : prednisolone , ox and rolone , or placebo . During the 30 days , mortality in the groups receiving steroid therapy was not significantly different from mortality in the placebo group . Thirteen per cent of the moderately ill patients and 29 per cent of the severely ill patients died . Although neither steroid improved short-term survival , ox and rolone therapy was associated with a beneficial effect on long-term survival . This was especially true in patients with moderate disease : among those who survived for one or two months after the start of treatment the conditional six-month death rate was 3.5 per cent after ox and rolone and 19 to 20 per cent after placebo ( P = 0.02 ) . No consistent long-term effect was associated with prednisolone therapy 
    Output:
    
Glucocorticosteroids significantly reduced mortality in the subgroup of trials with patients with Maddrey 's score of at least 32 or hepatic encephalopathy and with low-bias risk .
Trial sequential analyses using heterogeneity-adjusted information size demonstrated no significant effect of glucocorticosteroids on mortality .
Weighted logistic regression analyses taking prognostic factors at r and omization into consideration found no significant effect of glucocorticosteroids on mortality .
CONCLUSIONS The current evidence base of mainly heterogeneous with high bias risk trials does not support the use of glucocorticosteroids in alcoholic hepatitis .