This protocol addresses patients with severe alcoholic hepatitis confirmed by a modified Maddrey discriminant function (mDF) ≥32 or a Glasgow Alcoholic Hepatitis Score (GAHS) ≥9 — two thresholds that identify a population with poor prognosis and a demonstrated 84-day survival benefit from specific therapy.
First-line treatment for this population includes alcohol abstinence, nutritional support, and a corticosteroid course (prednisolone or methylprednisolone). Therapeutic response is evaluated at day 7 using the Lille score. A Lille score ≥0.45 at day 7 indicates non-response — the target of corticosteroid therapy was not achieved — and escalation to this next-line protocol is warranted.
When corticosteroid therapy fails to meet the day-7 Lille score target, the structured next step involves stopping the corticosteroid course. Beyond that initial action, the complete escalation pathway — including the criteria and considerations for a more intensive intervention in a highly selected subset of patients — is detailed in the full protocol.
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.
In case of poor response, it is recommended that corticosteroids be interrupted, particularly in "null responders" (defined by Lille score ≥0.56).
In case of non-response to corticosteroids, highly selected patients should be considered for early liver transplantation.
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