• The diagnosis of alcoholic hepatitis (AH) should be made using the published consensus criteria.
• Lab-based prognostic scores should be used to assess prognosis in AH.
• The Maddrey discriminant function (MDF) (≥32) should be used to evaluate the need for treatment with corticosteroids or other medical therapies.
• A Model for End-Stage Liver Disease (MELD) score greater than 20 also should be the criteria for consideration of steroid treatment.
• Encourage these patients to abstain from alcohol to improve long-term prognosis in AH.
• Prednisolone (40 mg/day) should be administered orally to improve 28-day mortality in patients with severe AH (MDF ≥32) without contraindications to the use of corticosteroid
• The addition of intravenous N-acetylcysteine to prednisolone (40 mg/day) may enhance the 30-day survival of patients with severe AH.
• The Lille score should be used to re-evaluate prognosis, identify nonresponders, and guide treatment course after 7 days of corticosteroids.
• Treatment of malnutrition should be done in patients with AH, preferably with enteral nutrition.
• Abstinence is essential for long-term survival; thus, methods used for treatment of AUDs should be utilized to improve abstinence.
• Pentoxifylline is no longer recommended in the treatment of AH.

Recommendations for Liver Transplantation for ALD

• Child-Pugh-Turcotte class C or MELD-Na of at least 21 should be referred and considered for liver transplantation in patients with decompensated alcohol-associated cirrhosis.
• Selection of appropriate candidate for liver transplantation in alcohol-associated cirrhosis should not be dependent solely on a fixed interval of abstinence.
• Liver transplantation may be considered in cautiously selected patients with positive psychosocial profiles in severe AH not responding to medical therapy.

Source: Crabb DW, Im GY, Szabo G, Mellinger JL, Lucey MR. Diagnosis and Treatment of Alcohol-Associated Liver Diseases: 2019 Practice Guidance From the American Association for the Study of Liver Diseases. AASLD. January 2020;71(1). Available at:

https://aasldpubs.onlinelibrary.wiley.com/doi/full/10.1002/hep.30866