Initial Treatment for Alcoholic Hepatitis

Assessment of Disease Severity

The American Association for the Study of Liver Diseases recommends evaluating disease severity using validated scoring systems, including Maddrey discriminant function (MDF) >32, MELD score >20, Glasgow alcoholic hepatitis score of 9, and ABIC score category C, to guide treatment decisions 1, 4
The American College of Gastroenterology suggests that all patients should be screened for infections regardless of fever presence, with cultures of blood, urine, and ascites (if present) 1, 4

The American College of Gastroenterology recommends complete abstinence from alcohol as essential for treatment, as continued alcohol use leads to disease progression and worsens outcomes 1, 2
The European Association for the Study of the Liver suggests providing high-calorie, high-protein diet: 30-40 kcal/kg/day and 1.2-1.5 g/kg/day protein 1, 6

For severe alcoholic hepatitis (MDF ≥32, MELD >20), the American Association for the Study of Liver Diseases recommends corticosteroid therapy with prednisolone 40 mg daily for 28 days (followed by discontinuation or 2-week taper) 2, 3
The American College of Gastroenterology suggests assessing response to steroids at day 7 using the Lille model or Early Change in Bilirubin Level (ECBL), with Lille score <0.45 indicating good response (85% 6-month survival) and Lille score >0.45 indicating poor response (25% 6-month survival) 1, 3

The American College of Gastroenterology recommends avoiding nephrotoxic drugs, including diuretics, as acute kidney injury is an early manifestation of multi-organ failure 1
The European Association for the Study of the Liver suggests using caution with iodinated contrast agents for imaging, as they increase the risk of acute kidney injury 1

The American Association for the Study of Liver Diseases recommends evaluating response to treatment at day 7 using the Lille model or ECBL 3
The American College of Gastroenterology suggests monitoring for infections, which can develop after initial diagnosis and are associated with high mortality 1