Atypical presentation and/or laboratory tests
(e.g., AST or ALT >400 U/L)
Uncertain alcohol intake history
Use of any potential hepatotoxic substance in the last 3 mo

Probable alcohol-associated
hepatitis Clinically diagnosed

Transjugular liver
biopsy recommended

Maddrey DF^* >32 or MELD score^† >20

Begin prednisolone 40 mg/day

Lille model^‡ score at 7 days

Complete 4 wk of prednisolone,
then taper over 2 wk

Stop prednisolone and consider the following:
Early LT for select patients
Clinical trial
Discussion of goals of care if ≥4 organ failures

Possible alcohol-associated
hepatitis Clinically suspected

Further evaluation for
and/or treatment of an
alternative cause of
liver disease
(see Table 86.8)

Definite alcohol-associated
hepatitis Biopsy proven

The Maddrey discriminant function (DF) is calculated as follows: 4.6 (prothrombin time of patient 2 prothrombin time of control) 1 serum bilirubin level (in mg/dl).

† The MELD score is based on the serum bilirubin level,international normalization ratio, and serum creatinine level.

The Lille model score is based on the patient’s age, serum albumin, serum bilirubin, serum creatinine, and prothrombin time. Online calculators for these various models are available at http://www.lillemodel.com. (From Feldman M et al: Sleisenger and Fordtran’s gastrointes tinal and liver disease, ed 11, Philadelphia, 2021, Elsevier.)