Alcoholic Hepatitis and Alcohol-Related Acute on Chronic Liver Failure

Joseph C. Ahn, Vijay H. Shah

Research output: Chapter in Book/Report/Conference proceedingChapter


Alcoholic hepatitis (AH) occurs in patients with chronic and heavy alcohol consumption, via a complex interplay of pathways involving direct hepatocyte injury, intestinal dysbiosis and activation of pro-inflammatory cascade. Severe AH is defined by Maddrey discriminant function ≥32 or MELD score ≥ 20 and is often associated with systemic inflammatory response syndrome leading to acute-on chronic liver failure (ACLF). A liver biopsy is required to make a definitive diagnosis of AH, although a probable diagnosis of AH can be made in patients with history of heavy drinking and typical liver enzyme abnormalities. The only available pharmacologic therapy for severe AH is corticosteroids, but its utilities are limited by lack of long-term benefit and a significant portion of non-responders. Novel biomarkers and treatment approaches are being investigated with varying degrees of success. Recently, early liver transplantation prior to the traditional 6-month period of sobriety has emerged as a promising option for certain patients with severe AH and ACLF.

Original languageEnglish (US)
Title of host publicationLiver Failure
Subtitle of host publicationAcute and Acute on Chronic
PublisherSpringer International Publishing
Number of pages22
ISBN (Electronic)9783030509835
ISBN (Print)9783030509828
StatePublished - Oct 30 2020


  • Alcohol-related acute-on-chronic liver failure (ALD-ACLF)
  • Alcoholic hepatitis (AH)
  • Biomarkers
  • CLIF-C ACLF Score
  • Corticosteroids
  • Lille score
  • Liver transplantation
  • Maddrey discriminant function (MDF)
  • Model for end-stage liver disease (MELD) score
  • Transjugular liver biopsy

ASJC Scopus subject areas

  • Medicine(all)


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