Summary of findings for the main comparison.

Glucocorticosteroids for people with alcoholic hepatitis

Glucocorticosteroids for people with alcoholic hepatitis
Patient or population: participants with alcoholic hepatitis at high risk of mortality and morbidity Settings: hospitals and clinics Intervention: glucocorticosteroids Comparison: placebo or no intervention
Outcomes	Illustrative comparative risks* (95% CI)		Relative effect (95% CI)	No of participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Placebo or no intervention	Glucocorticosteroids
All‐cause mortality: 3 months following randomisation	298 per 1000	278 per 1000	RR 0.90 (0.70 to 1.15)	1861 (15 RCTs)	⊕⊝⊝⊝1 very low	The Trial Sequential Analysis‐adjusted CI was 0.36 to 2.32
Health‐related quality of life: up to 3 months (measured withEuropean Quality of Life ‐ 5 Dimensions‐3 Levels (EQ‐ 5D‐3L) scale)	The mean value is 0.592	The mean value is 0.553	MD ‐0.04; (‐0.11 to 0.03)	377 (1 RCT)	⊕⊕⊝⊝2 low	We did not perform Trial Sequential Analysis
Serious adverse events during treatment	361 per 1000	389 per 1000	RR 1.05 (0.85 to 1.29)	1861 (15 RCTs)	⊕⊕⊝⊝3 low	The Trial Sequential Analysis‐adjusted CI was 0.60 to 1.82
Liver‐related mortality: up to 3 months following randomisation	298 per 1000	277 per 1000	RR 0.89 (0.69 to 1.14)	1861 (15 RCTs)	⊕⊕⊝⊝4 low	The Trial Sequential Analysis‐adjusted CI was 0.32 to 2.45
Any complication: up to 3 months following randomisation	443 per 1000	474 per 1000	RR 1.04 (0.86 to 1.27)	1861 (15 RCTs)	⊕⊕⊝⊝5 low	The Trial Sequential Analysis‐adjusted CI was 0.67 to 1.63
Number of participants with non‐serious adverse events: up to 3 months' follow‐up after end of treatment	51 per 1000	120 per 1000	RR 1.99 (0.72 to 5.48)	160 (4 RCTs)	⊕⊝⊝⊝6 very low	The Trial Sequential Analysis‐adjusted CI was 0.01 to 249.60
*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RCT: randomised controlled trial; RR: risk ratio
GRADE Working Group grades of evidence High quality: this research provides a very good indication of the likely effect; the likelihood that the effect will be substantially different is low. Moderate quality: this research provides a good indication of the likely effect; the likelihood that the effect will be substantially different is moderate. Low quality: this research provides some indication of the likely effect; however, the likelihood that it will be substantially different is high. Very low quality: this research does not provide a reliable indication of the likely effect; the likelihood that the effect will be substantially different is very high.

¹Downgraded 3 levels: 1 level due to within‐study risk of bias (high overall risk of bias in all the trials); 1 level due to inconsistency of the data (there is wide variation in the effect estimates across studies; there is little overlap of confidence intervals associated with the effect estimates; presence of moderate heterogeneity: I² = 45%; heterogeneity could be explained with selection bias); 1 level due to imprecision of effect estimates (the trial sequential analysis showed that additional evidence is needed and that we have not yet reached the required information size). ²Downgraded 2 levels: 1 level due to within‐study risk of bias (high overall risk of bias in the trial); 1 level due to imprecision of effect estimates. ³Downgraded 2 levels: 1 level due to within‐study risk of bias (high overall risk of bias in all the trials); 1 level due to inconsistency of the data (there is wide variation in the effect estimates across studies; there is little overlap of confidence intervals associated with the effect estimates; presence of moderate heterogeneity: I² = 36%; heterogeneity could be explained with selection bias). ⁴Downgraded 2 levels: 1 level due to within‐study risk of bias (high overall risk of bias in all the trials); 1 level due to inconsistency of the data (there is wide variation in the effect estimates across studies; there is little overlap of confidence intervals associated with the effect estimates; presence of moderate heterogeneity: I² = 46%; heterogeneity could be explained with selection bias). ⁵Downgraded 2 levels: 1 level due to within‐study risk of bias (high overall risk of bias in all the trials); 1 level due to inconsistency of the data (there is wide variation in the effect estimates across studies; there is little overlap of confidence intervals associated with the effect estimates; presence of moderate heterogeneity: I² = 41%; heterogeneity could be explained with selection bias). ⁶Downgraded 4 levels: 1 level due to within‐study risk of bias (high overall risk of bias in all the trials); 1 level due to inconsistency of the data (there is little overlap of confidence intervals associated with the effect estimates);1 level due to imprecision of effect estimates (the Trial Sequential Analysis showed that additional evidence is needed and that we have not yet reached the required information size); 1 level due to publication bias (only 4 trials with a small number of participants reported on non‐serious adverse events).