Algorithm for the Management of Patients with Alcoholic Hepatitis - Flowchart

Algorithm for the Management of Patients with Alcoholic Hepatitis - Flowchart

Algorithm for the Management of Patients with Alcoholic Hepatitis - Flowchart Alcoholic Hepatitis Alcoholic Hepatitis

«Flowchart»

Alcoholic hepatitis

Alcoholic hepatitis

Alcoholic hepatitis

Poor prognosis: consider specific therapy

Poor prognosis: consider specific therapy

Poor prognosis: consider specific therapy

Good prognosis: nutritional support and conservative management

Good prognosis: nutritional support and conservative management

Good prognosis: nutritional support and conservative management

End

End

End

Pentoxifylline 400 mg three times daily for 28 days (controversial)

Pentoxifylline 400 mg three times daily for 28 days (controversial)

Pentoxifylline 400 mg three times daily for 28 days (controversial)

Prednisone 40 mg for 7 days. If serum bilirubin level decreases, continue prednisone 40 mg daily for an additional 21 days, followed by a 2-wk taper. If bilirubin level does not decrease, stop treatment after 7 days.

Prednisone 40 mg for 7 days. If serum bilirubin level decreases, continue prednisone 40 mg daily for an additional 21 days, followed by a 2-wk taper. If bilirubin level does not decrease, stop treatment after 7 days.

Prednisone 40 mg for 7 days. If serum bilirubin level decreases, continue prednisone 40 mg daily for an additional 21 days, followed by a 2-wk taper. If bilirubin level does not decrease, stop treatment after 7 days.

Active GI bleeding, systemic infection, or renal insufficiency

Active GI bleeding, systemic infection, or renal insufficiency

Active GI bleeding, systemic infection, or renal insufficiency

Yes

Yes

Yes

No

No

No

^* The DF is calculated as follows: 4.6 (prothrombin time of patient – prothrombin time of control) + serum bilirubin level (in mg/dl).

^* The DF is calculated as follows: 4.6 (prothrombin time of patient – prothrombin time of control) + serum bilirubin level (in mg/dl).

^* The DF is calculated as follows: 4.6 (prothrombin time of patient – prothrombin time of control) + serum bilirubin level (in mg/dl).

^*

^† The Model for End-Stage Liver Disease score is based on the serum bilirubin level, INR, and serum creatinine level.

^† The Model for End-Stage Liver Disease score is based on the serum bilirubin level, INR, and serum creatinine level.

^† The Model for End-Stage Liver Disease score is based on the serum bilirubin level, INR, and serum creatinine level.

^†

^‡ The Glasgow alcoholic hepatitis score is based on the patient's age, white blood cell count, blood urea nitrogen level, ratio of prothrombin time to a control value, and serum bilirubin level.

^‡ The Glasgow alcoholic hepatitis score is based on the patient's age, white blood cell count, blood urea nitrogen level, ratio of prothrombin time to a control value, and serum bilirubin level.

^‡ The Glasgow alcoholic hepatitis score is based on the patient's age, white blood cell count, blood urea nitrogen level, ratio of prothrombin time to a control value, and serum bilirubin level.

^‡

DF, Discriminant function.

DF, Discriminant function.

DF, Discriminant function.

DF

Hepatic encephalopathy or at least one of the following:

DF^* 32,
MELD^† score 18, or
Glasgow score^‡ 9

Hepatic encephalopathy or at least one of the following:

DF^* 32,
MELD^† score 18, or
Glasgow score^‡ 9

Hepatic encephalopathy or at least one of the following:

DF^* 32,
MELD^† score 18, or
Glasgow score^‡ 9

DF^* 32, ^* ^*
MELD^† score 18, or ^† ^†
Glasgow score^‡ 9 ^‡ ^‡

Yes

Yes

Yes

No

No

No