Alcoholic hepatitis
ICD-10 K70.1 · ICD-11 DB94.1

Treatment of Alcoholic Hepatitis with Modified Maddrey Discriminant Function <32 and Glasgow Alcoholic Hepatitis Score <9

This protocol addresses patients with non-severe alcoholic hepatitis — specifically those with a modified Maddrey discriminant function (mDF) below 32 and a Glasgow alcoholic hepatitis score (GAHS) below 9.

Clinical context

Patients who meet the mDF <32 threshold fall into the non-severe category, associated with a one-month mortality risk below 10%. Confirming non-severity using both the mDF and GAHS is the critical first step before selecting the appropriate management pathway.

Treatment approach — partial overview

Alcohol abstinence is the cornerstone of care for all patients in this group. The management approach also incorporates vitamin supplementation and a structured nutritional plan. Corticosteroid therapy is not indicated at this severity level. The complete regimen — including the specific interventions, parameters, and sequencing — is available in the full protocol below.

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References

DOI: 10.1016/j.jhep.2018.03.018

  1. Patients with a non-severe AH (i.e. mDF <32) had a less than 10% risk of one-month mortality.
  2. Regardless of the severity, alcohol abstinence is the cornerstone of therapy and early management of AUD is recommended in all patients with AH.
  3. Considering the potential risk of Wernicke's encephalopathy, supplementation with B-complex vitamins is recommended.
  4. 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.
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