From the Guidelines
Alcoholic hepatitis typically presents with a recent onset of jaundice, often accompanied by fever, malaise, weight loss, and malnutrition, in patients with a history of heavy alcohol use. The clinical presentation of alcoholic hepatitis can vary, but common symptoms include jaundice, right upper quadrant abdominal pain, hepatomegaly, and signs of liver decompensation such as ascites and encephalopathy 1. Laboratory findings often show elevated liver enzymes with AST typically higher than ALT (AST:ALT ratio >1.5), elevated bilirubin, prolonged prothrombin time, and leukocytosis 1.
Some key features of alcoholic hepatitis include:
- Progressive jaundice
- Fever with or without infection
- Weight loss and malnutrition
- Tender hepatomegaly
- Ascites and encephalopathy in severe cases
- Elevated AST and ALT with an AST:ALT ratio >1.5
- Elevated bilirubin and prolonged prothrombin time
The diagnosis of alcoholic hepatitis is based on clinical and laboratory findings, and liver biopsy can be useful in confirming the diagnosis and assessing prognosis 1. However, the decision to perform a liver biopsy should be made on a case-by-case basis, taking into account the availability of the procedure and the experience of the team. The most recent and highest quality study recommends that liver biopsy be performed only in cases where there is diagnostic uncertainty 1.
In terms of prognosis, the severity of alcoholic hepatitis can range from mild to severe, with severe cases having a high mortality rate 1. Discriminator functions like Maddrey's Discriminant Function (DF) or the MELD score can help assess severity and guide treatment decisions. Early recognition of this condition is crucial as mortality increases significantly with disease severity. The current evidence suggests that treatment for severe alcoholic hepatitis may include corticosteroids or pentoxifylline, as well as nutritional support, alcohol abstinence, and management of complications 1.
From the Research
Clinical Presentation of Alcoholic Hepatitis
- The clinical presentation of alcoholic hepatitis is characterized by fatigue, malaise, and jaundice in individuals who have abused excessive quantities of alcohol 2.
- Common early presenting signs and symptoms of alcohol abuse include anorexia, weight loss, fatigue, symptoms of alcohol withdrawal, and hepatomegaly 3.
- The clinical diagnosis of alcoholic hepatitis can be made in alcoholics with associated fever, leukocytosis, jaundice, and tender hepatomegaly 3.
- Laboratory abnormalities may include leukocytosis or leukopenia, anemia, a prolonged prothrombin time, and elevated liver enzymes, including aspartate amino-transferase (AST), alanine aminotransferase (ALT), alkaline phosphatase, and bilirubin 3.
- An AST-to-ALT ratio greater than 2 is common in patients with alcoholic hepatitis 3.
Diagnosis and Prognosis
- The diagnosis of alcoholic hepatitis is primarily clinical, based on a consensus definition from the National Institute on Alcohol Abuse and Alcoholism 4.
- Laboratory-based prognostic scores, including Maddrey Discriminant Function and the Model for End-Stage Liver Disease, help determine disease severity and treatment options 4.
- The Lille score at day 7 of treatment is used to evaluate responsiveness to corticosteroid therapy 4.
- Baseline prothrombin time (BPT) can predict the response to steroid therapy in severe alcoholic hepatitis, with higher BPT values associated with a lower likelihood of response 5.
Treatment and Management
- Treatment for moderate disease primarily consists of supportive care, including alcohol cessation and nutritional support 4.
- Corticosteroids are recommended for severe alcoholic hepatitis, with the goal of reducing short-term mortality 6, 4.
- Pharmacologic treatment of alcohol use disorder can aid patients in maintaining abstinence from alcohol 4.
- Long-term follow-up should focus on abstinence from alcohol, management of underlying cirrhosis, and evaluation for liver transplantation if indicated 4.