علاج التهاب الكبد الكحولي بوظيفة التمييز المعدلة لمادري (mDF) ≥32 أو درجة جلاسكو للتهاب الكبد الكحولي (GAHS) ≥9

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.