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Management and prognosis of alcoholic hepatitis

Scott L Friedman, MD
Section Editor
Bruce A Runyon, MD
Deputy Editor
Kristen M Robson, MD, MBA, FACG


Excessive alcohol consumption is associated with a range of hepatic manifestations and takes a significant toll on human health throughout the world [1,2]. In the United States, the burden of alcoholic hepatitis is increasing [3]. Hepatic manifestations include alcoholic fatty liver disease (with or without steatohepatitis), alcoholic hepatitis, and cirrhosis. While asymptomatic steatohepatitis due to alcohol could be referred to as "alcoholic hepatitis," the term is typically used to describe the acute onset of symptomatic hepatitis. The amount of alcohol intake that puts an individual at risk for alcoholic hepatitis is not known, but the majority of patients have a history of heavy alcohol use (more than 100 g/day) for two or more decades (figure 1) [4,5].

This topic will review the prognosis and management of patients with alcoholic hepatitis. The pathogenesis of alcoholic liver disease, the clinical manifestations and diagnosis of alcoholic hepatitis, and the approach to patients with alcoholic fatty liver disease or alcoholic cirrhosis are discussed separately. (See "Pathogenesis of alcoholic liver disease" and "Alcoholic hepatitis: Clinical manifestations and diagnosis" and "Clinical manifestations and diagnosis of alcoholic fatty liver disease and alcoholic cirrhosis" and "Prognosis and management of alcoholic fatty liver disease and alcoholic cirrhosis".)

Guidelines for the management of patients with alcoholic liver disease have been issued by the American Association for the Study of Liver Diseases and by the American Gastroenterological Association [6,7]. The discussion that follows is generally consistent with those guidelines.


Several models have been proposed to determine the severity of a patient's alcoholic hepatitis [8,9]. The Maddrey discriminant function and the Model for End-stage Liver Disease (MELD) score are the most commonly used to help identify patients who are more likely to benefit from pharmacologic therapy. Other validated scores include the Glasgow alcoholic hepatitis score, the ABIC score (which includes age, serum bilirubin, international normalized ratio, and serum creatinine), and the Lille score (which is used to determine if a patient is responding to treatment) [8,10,11]. (See 'Glucocorticoids' below.)

Maddrey discriminant function — Disease severity and mortality risk in patients with alcoholic hepatitis may be estimated using the Maddrey discriminant function (DF, also known as the Maddrey score), which is calculated as follows (calculator 1) [12,13]:

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Literature review current through: Dec 2017. | This topic last updated: Oct 18, 2017.
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