From the Guidelines
Alcoholic hepatitis is defined by lab values including neutrophilia, hyperbilirubinemia (>50 μMol/L), serum levels of AST greater than twice the upper limit of normal range, AST >50 IU/ml, and an AST/ALT ratio typically greater than 1.5–2.0, as stated in the EASL clinical practice guidelines 1.
Key Lab Values
- Neutrophilia
- Hyperbilirubinemia (>50 μMol/L)
- Elevated serum AST (>50 IU/ml and twice the upper limit of normal range)
- AST/ALT ratio > 1.5–2.0
- Prolonged prothrombin time, hypoalbuminemia, and decreased platelet count in severe forms
Diagnosis
The diagnosis of alcoholic hepatitis is based on clinical and laboratory findings, including a history of heavy alcohol use, recent onset of jaundice, and typical laboratory results, as outlined in the EASL guidelines 1. A liver biopsy can be useful to confirm the diagnosis, but it is not always necessary, especially in cases where the clinical and laboratory findings are typical, as noted in the French Association for the Study of the Liver and the French Alcohol Society clinical guidelines 1.
Severity Assessment
The severity of alcoholic hepatitis can be assessed using scores such as the Maddrey Discriminant Function and the MELD score, as recommended in the French Association for the Study of the Liver and the French Alcohol Society clinical guidelines 1. These scores can help identify patients with severe disease who may require specific treatment, such as corticosteroids.
Management
The management of alcoholic hepatitis involves stopping alcohol consumption, nutritional support, and potentially corticosteroid therapy in severe cases, as outlined in the EASL guidelines 1 and the French Association for the Study of the Liver and the French Alcohol Society clinical guidelines 1. The Lille score can be used to assess the response to corticosteroid therapy and identify patients who may require alternative treatments, as recommended in the French Association for the Study of the Liver and the French Alcohol Society clinical guidelines 1.
From the Research
Definition of Alcoholic Hepatitis by Labs
Alcoholic hepatitis can be defined by laboratory values, including:
- Leukocytosis or leukopenia, anemia, a prolonged prothrombin time and elevated liver enzymes, including aspartate amino-transferase (AST), alanine aminotransferase (ALT), alkaline phosphatase and bilirubin 2
- An AST-to-ALT ratio greater than 2 is common in patients with alcoholic hepatitis 2, 3
- Elevated gamma-glutamyltranspeptidase (GGT) and mean corpuscular volume (MCV) 4, 5
- Increased IgA to IgG ratio 5
Laboratory Abnormalities
Laboratory abnormalities associated with alcoholic hepatitis may include:
- Elevated serum bilirubin greater than 5 mg/dL 3
- Neutrophil leukocytosis 3
- Coagulopathy 3
- Elevated liver enzymes, including AST, ALT, and alkaline phosphatase 2, 4, 5
Diagnostic Criteria
The diagnosis of alcoholic hepatitis can be made based on: