What are the laboratory findings in Alcoholic Hepatitis (AH)?

From the Guidelines

Alcoholic hepatitis is characterized by a distinctive laboratory profile, including elevated liver enzymes with an AST/ALT ratio greater than 2:1, elevated total bilirubin, prolonged prothrombin time, and hypoalbuminemia, as noted in the 2022 study by the French Association for the Study of the Liver and the French Alcohol Society 1. The diagnosis of alcoholic hepatitis is based on clinical and laboratory findings, including a history of heavy alcohol use, recent onset of jaundice, and elevated liver enzymes, as outlined in the 2018 EASL clinical practice guidelines 1. Key laboratory findings in alcoholic hepatitis include:

• Elevated AST and ALT, with an AST/ALT ratio greater than 2:1
• Elevated total bilirubin, often greater than 3 mg/dL in severe cases
• Prolonged prothrombin time
• Elevated gamma-glutamyl transferase (GGT)
• Macrocytic anemia with elevated MCV
• Leukocytosis with neutrophilia, particularly in severe cases
• Hypoalbuminemia, reflecting impaired liver synthetic function These laboratory values are essential for calculating prognostic scores, such as the Maddrey's Discriminant Function, MELD score, or Glasgow Alcoholic Hepatitis Score, which help determine disease severity and guide treatment decisions, as discussed in the 2017 study by the American Gastroenterological Association Institute 1. Serial monitoring of these parameters is crucial to track disease progression and response to interventions, such as nutritional support, corticosteroids, or pentoxifylline, as recommended in the 2022 guidelines by the French Association for the Study of the Liver and the French Alcohol Society 1. In addition to laboratory findings, the diagnosis of alcoholic hepatitis should also consider clinical criteria, such as the presence of jaundice, ascites, and encephalopathy, as well as the patient's history of alcohol use, as outlined in the 2012 EASL clinical practice guidelines 1. The Lille score, which integrates patient characteristics and the change in bilirubin levels during the first week of treatment, is a useful tool for assessing the response to corticosteroid therapy and predicting short-term survival, as noted in the 2022 study by the French Association for the Study of the Liver and the French Alcohol Society 1. Overall, the diagnosis and management of alcoholic hepatitis require a comprehensive approach, incorporating both laboratory and clinical findings, as well as consideration of the patient's overall health and prognosis, as discussed in the 2017 study by the American Gastroenterological Association Institute 1.

From the Research

Alcoholic Hepatitis Lab Reports

• Alcoholic hepatitis is a clinical syndrome characterized by jaundice and liver impairment that occurs in patients with a history of heavy and prolonged alcohol use 2.
• Severe alcoholic hepatitis (SAH) is defined by modified Maddrey discriminant function ≥32 or Model for End-Stage Liver Disease (MELD) >21 and/or hepatic encephalopathy 3.
• The diagnosis of alcoholic hepatitis is based on a combination of clinical, laboratory, and histological findings, including:
  • Clinical presentation: jaundice, fatigue, anorexia, fever, and ascites 4.
  • Laboratory findings: elevated liver enzymes, bilirubin, and international normalized ratio (INR) 5.
  • Histological findings: liver biopsy showing steatosis, inflammation, and fibrosis 5.

Management of Alcoholic Hepatitis

• The management of alcoholic hepatitis involves a combination of supportive care, pharmacological therapy, and liver transplantation in selected cases 5.
• Supportive care includes:
  • Abstinence from alcohol 5.
  • Nutritional support with high-calorie, high-protein diet 4.
• Pharmacological therapy includes:
  • Corticosteroids: prednisolone has been shown to reduce 28-day mortality, but with no improvement in outcomes at 90 days or 1 year 2.
  • Pentoxifylline: has not been shown to improve survival in patients with alcoholic hepatitis 6, 2.
• Liver transplantation may be considered in highly selected patients with severe alcoholic hepatitis who are nonresponsive to medical treatment 3, 4.

Prognosis of Alcoholic Hepatitis

• The prognosis of alcoholic hepatitis is poor, with a 3-month mortality rate ≥30-70% in severe cases 3.
• The prognosis can be predicted using scoring systems such as the Maddrey discriminant function and the Model for End-Stage Liver Disease (MELD) score 5, 3.
• Early recognition and treatment of alcoholic hepatitis can improve outcomes, and liver transplantation may be considered in selected cases 5, 3.