Treatment of Alcoholic Hepatitis with Modified Maddrey Discriminant Function (mDF) ≥32 or Glasgow Alcoholic Hepatitis Score (GAHS) ≥9
Both the modified Maddrey discriminant function and the Glasgow Alcoholic Hepatitis Score are used to identify patients with severe alcoholic hepatitis who carry a poor short-term prognosis and who benefit most from active treatment. This page outlines the clinical picture and points to the full structured regimen.
Clinical Scenario
An mDF cut-off of ≥32 identifies severe alcoholic hepatitis and is the standard threshold for initiating specific therapy. Similarly, a GAHS of ≥9 marks patients at high risk. In this population, studies demonstrate an 84-day survival benefit when appropriate treatment is started promptly.
mDF ≥32
GAHS ≥9
Severe alcoholic hepatitis
Treatment Goals
Response to treatment is formally evaluated at day 7 using the Lille score. A Lille score below 0.45 at that time point confirms a favourable response and guides continuation of the treatment course through 28 days.
Treatment Approach — Overview
Management involves alcohol abstinence as the cornerstone of care, alongside nutritional support, vitamin supplementation, and — where there is no contraindication — a defined course of corticosteroid therapy. Further options exist to complement this approach in eligible patients.
The complete regimen — including eligibility criteria, sequencing, response-guided decisions, and all dosing specifics — is available in the full structured protocol.
References
DOI: 10.1016/j.jhep.2018.03.018
- In its modified version, a cut-off value of 32 identifies patients with severe AH and is usually the threshold used for initiating specific therapy.
- The GAHS ranges from 5 to 12 and patients with an mDF ≥32 and a GAHS ≥9 have a poor prognosis and an 84-day survival benefit when treated with corticosteroid.
- Regardless of the severity, alcohol abstinence is the cornerstone of therapy and early management of AUD is recommended in all patients with AH.
- Considering the potential risk of Wernicke's encephalopathy, supplementation with B-complex vitamins is recommended.
- A careful evaluation of nutritional status should be performed and patients should aim to achieve a daily energy intake ≥35–40 kcal/kg BW and 1.2–1.5 g/kg protein, and to adopt the oral route as first-line intervention.
- In the absence of active infection, corticosteroids should be considered in patients with severe AH to reduce short-term mortality.
- The Lille score allows clinicians to predict poor response to corticosteroids at seven days of therapy.
- This score ranges from 0 to 1; a score ≥0.45 indicates non-response to corticosteroids.
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