Pharmacotherapy of acute alcoholic hepatitis in clinical practice

Table 1 Common scoring system used to predict prognosis in alcoholic hepatitis

Score name	Score formula				8- to 30-d mortality
Maddrey’s discriminant function[31]	4.6 × [PT (s) - lab control PT (s)] + serum bilirubin (mg/dL)				Sensibility: 0.75
					Specificity: 0.69
Model for end-stage liver disease[32]	3.78 × [Ln serum bilirubin (mg/dL)] + 11.2 × [Ln INR] + 9.57 × [Ln serum creatinine (mg/dL)] + 6.43				Sensibility: 0.69-0.75
					Specificity: 0.68-0.75
Glasgow alcoholic hepatitis score[33]	Score given	1	2	3	Sensibility: 0.67
	Age	< 50	≥ 50	-	Specificity: 0.70
	WCC (109/L)	< 15	≥ 15	-
	Urea (mmol/L)	< 5	≥ 5	-
	PT ratio or INR	1.5	1.5-2.0	> 2.0
	Bilirubin (μmol/L)	< 125	125-250	> 250
ABIC score[34]	(age × 0.1) + [serum bilirubin (mg/dL) × 0.08] + [serum creatinine (mg/dL) × 0.3] + (INR × 0.8)				Sensibility: 0.92
					Specificity: 0.32
Lille model score[35]	exp(-R)/[1 + exp(-R)]1				Sensibility: 0.76
					Specificity: 0.66

¹R = 3.19-0.101 × (age in years) + 0.147 × (albumin day 0 in g/L) + 0.0165 × [bilirubin day 0 - bilirubin day 7 (mmol/L)] - 0.206 × (renal insufficiency) - 0.0065 × (bilirubin day 0 in mmol/L) - 0.0096 × (PT in seconds). PT: Prothrombin time; INR: International normalised ratio; WCC: White cell count.

Table 2 Treatment considerations of severe alcoholic hepatitis

Treatment	Options	Comments
Corticosteroids	Prednisolone	If MDF ≥ 32: 40 mg daily orally for 28 d followed by a 2/4-wk taper
Phosphodiesterase inhibitors	Pentoxyfilline	400 mg orally 3 times daily for 4 wk
Anti TNF-α	Infliximab	Infliximab 5 mg/kg iv at day 0 and prednisone 40 mg/d for 28 d (data not confirmed)
Nutrition	Eating, tube feeding	Diet rich in carbohydrate- and protein-derived calories; potassium replacement; vitamin supplementation
Antioxidant	Metadoxine	1500 mg/d orally for 3 mo
Antioxidant	S-adenosylmethionine	1200 mg/d orally in ambulatory patients
Alcohol abstinence	Rehab program disulfiram, naltrexone, acamprosate, baclofen	Reduce alcohol withdrawal symptoms, alcohol craving and intake, promote abstinence, evaluation for OLT program

MDF: Maddrey’s discriminant function; OLT: Orthotopic liver transplantation; TNF-α: Tumor necrosis factor-α.