Stratification and selection of therapies to improve survival in severe alcoholic hepatitis

Figure 1 Clinical sub-classification of patients with severe alcoholic hepatitis. Index presentation patient can present either without acute-on-chronic liver failure (ACLF) with varying degrees of fibrosis or ACLF, mostly fulfilling Asian Pacific Association for the Study of Liver criteria. Previously diagnosed cases can decompensate with relapse and can present either as Acute or non-acute decompensation or ACLF.

Figure 2 Algorithm for management of severe alcoholic hepatitis. Steroids are the mainstay of treatment. Response to steroids is assessed at day 7 by Lille score. Steroid non-responder or steroid-ineligible can be considered for rescue therapies on case to case basis. SAH: Severe alcoholic hepatitis; LT: Liver transplant; MELD: Model for end stage liver disease; mDF: Maddrey’s discriminant function; TLC: Total leucocyte count; AKI: Acute kidney injury; PLEX: Plasma exchange; GCSF: Granulocyte colony stimulating factor.