O’Shea et al reported an algorithm for managing a patient with alcoholic hepatitis. The authors are from the Practice Guideline Committee of the American Association for the Study of Liver Diseases and the Practice Parameters Committee of the American College of Gastroenterology.


Patient selection: hospital admission for alcoholic hepatitis


Criteria for high risk – any of the following:

(1) modified Maddrey discriminant function >= 32 (see 11.07.05)

(2) presence of hepatic encephalopathy

(3) MELD score >= 18


Criteria for low risk:

(1) modified Maddrey discriminant function < 32 AND decrease in serum total bilirubin during first week in hospital

(2) MELD score < 18 AND MELD score decrease during first week in hospital by >= 2 points


If the patient is high risk and the diagnosis is uncertain then consider performing a liver biopsy.


All patients should undergo:

(1) a nutritional assessment and intervention.

(2) abstinence counseling

(3) evaluation and management of comorbid conditions

High Risk Patient

Drug Therapy

early renal failure OR corticosteroids contraindicated

pentoxifylline (400 mg po tid for 4 weeks)

normal renal function AND corticosteroids not contraindicated

prednisolone 40 mg/day for 28 days with or without 2 week taper


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