Alcoholic liver disease: Current insights into cellular mechanisms

Table 1 Models for clinical staging in alcoholic liver disease

Model	Stratification	Bilirubin	Albumin	Prothrombin Time	Ascites	Encephalopathy	INR	Creatinine	White blood cell count	Serum urea	Age
Child-Pugh[65,66]	Severe: ≥ 10	+	+	+	+	+
Model for End-Stage Liver disease[66]	Severe: ≥ 21	+					+	+
Maddrey Discriminant Function score[66]	Severe: ≥ 32	+		+
The Glasgow Alcoholic Hepatitis Score[66]	Poor prognosis: ≥ 9	+		+					+	+	+
Lille Model[66,69]	≥ 0.45: Nonresponse. < 0.45: Response	+	+	+				+			+

INR: International normalized ratio.

Table 2 Current available treatments for alcoholic liver disease

Intervention	Objective	Treatment method	Treatment effects
Abstinence	Stop drinking	Abstinence combined with disulfiram, naltrexone or acamprosate	Improve overall survival at all stages[70]. Acamprosate has been shown to be effective in reducing withdrawal symptoms[77]
Nutritional Therapy	Replenish nutrition	1.5 g protein and 35 to 49 kcal per kg of body weight. Supplementation with vitamins	Nutritional support showed improved hepatic encephalopathy and reduced infections in AH patients[80]
Corticosteroid	Anti-inflammatory	40 mg daily for 28 d, then 20 mg daily for 7 d, and 10 mg daily for 7 d	Short-term histological improvement has been documented, however, no improvement in long term survival[83]
Pentoxifylline	Anti-cytokine	400 mg orally three times a day for 4 wk	Reduction in the levels of cytokines and lower mortality rate[86]
Infliximab	Anti-cytokine	Not confirmed. 5 mg/kg studied	Further studies required. Treatment has shown to predispose patients to higher rate of infections as well as higher likelihood of mortality[93]
Liver transplantation	Surgery	Healthy ‘donor’ liver transplanted. 6 mo abstinence required	Transplantation has been shown to improve in quality of life[95,96]
N-acetylcysteine	Antioxidant	Not confirmed	In animal models NAC has been shown to prevent relapse and improve injury[111]. Further research is required
SAM	Antioxidant	Not confirmed	SAM therapy has improved survival and delayed the need for transplants however other studies have not found evidence to support or refute its use[102,103]
Silymarin	Herbal	Eurosil 85® 420 mg a day	Treatment with Silymarin reduced mortality and improved 4-yr overall survival in cirrhotic patients as well as improving liver function[119]
Betaine	Nutrient	Not confirmed	Animal models have shown betaine supplementation can attenuate alcoholic fatty liver[106-108,120,121]

AH: Alcoholic hepatitis; NAC: N-acetylcysteine; SAM: S-adenosyl methionine.