From the Guidelines
Laboratory values in alcoholic hepatitis typically show elevated liver enzymes, with aspartate aminotransferase (AST) usually higher than alanine aminotransferase (ALT), often with an AST:ALT ratio greater than 1.5-2.0, as well as hyperbilirubinemia (>50 μMol/L), and serum levels of AST greater than twice the upper limit of normal range. The diagnosis of alcoholic hepatitis is based on clinical and laboratory findings, including a history of heavy alcohol use, recent onset of jaundice, and laboratory results such as neutrophilia, hyperbilirubinemia, and elevated AST levels 1.
Key Laboratory Findings
- Elevated AST levels, typically 2-6 times the upper limit of normal range
- AST:ALT ratio greater than 1.5-2.0
- Hyperbilirubinemia (>50 μMol/L)
- Neutrophilia
- Elevated gamma-glutamyl transferase (GGT) levels
- Prolonged prothrombin time (PT) and international normalized ratio (INR)
- Hypoalbuminemia
- Elevated blood ammonia levels in severe cases
Assessment of Severity
The severity of alcoholic hepatitis can be assessed using scoring systems like the Maddrey's Discriminant Function, MELD score, or Glasgow Alcoholic Hepatitis Score, which incorporate laboratory values to guide treatment decisions 1.
Importance of Abstinence
Complete abstinence from alcohol is essential regardless of disease severity, as continued drinking significantly worsens outcomes. The management of alcoholic hepatitis involves a multidisciplinary approach, including medical treatment, nutritional support, and counseling for alcohol cessation 1.
Treatment and Prognosis
Treatment decisions are guided by the severity of the disease, and scoring systems such as the MELD score and Maddrey's Discriminant Function are used to predict mortality and guide treatment 1. The prognosis of alcoholic hepatitis is generally poor, with a high mortality rate within 90 days if left untreated or if the patient continues to drink alcohol 1.
From the Research
Alcoholic Hepatitis Lab Values
- The diagnosis of alcoholic hepatitis (AH) can be strongly suspected based on clinical and biochemical criteria, but a definitive diagnosis requires a liver biopsy 2.
- The prognosis of patients with AH can be established by different score systems, including Maddrey's Discriminant Function score, ABIC, MELD, and Glasgow 2.
- A histological scoring system, the Alcoholic Hepatitis Histological Score (AHHS), has been developed to estimate prognosis 2.
- Lab values such as bilirubin, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) are often elevated in patients with AH, but the specific values are not provided in the studies reviewed.
Treatment and Management
- Glucocorticoids, such as prednisolone, are currently the mainstay for treating severe AH in patients with Maddrey's Discriminant Function score > 32 3.
- Pentoxifylline has been shown to be individually useful in severe AH, but its efficacy in combination with prednisolone is unclear 4, 5.
- The combination of pentoxifylline and prednisolone yields no additional benefit in terms of mortality and morbidity compared to pentoxifylline monotherapy 4.
- Liver transplantation is a possible therapeutic option for severe AH, but it is rarely used due to the requirement of a 6-month abstinence period before listing for transplantation 3.
Prognosis and Outcomes
- The short-term mortality among patients with severe AH exceeds 30% 5.
- The prognosis of patients with AH can be poor, with up to 40-60% of patients dying within six months 3.
- The use of prednisolone has been associated with a reduction in 28-day mortality, but this did not reach significance, and there was no improvement in outcomes at 90 days or 1 year 5.