Alcoholic Hepatitis Diagnosis: Tests, Treatment, Outlook

Quick answer: Doctors pin down alcoholic hepatitis by matching a recent bingedrinking history with a classic lab patternAST higher than ALT (ratio>1.5), raised bilirubin, and a worsening Maddrey or MELD score. If those pieces line up, they can decide whether steroids, intensive nutrition, or even a transplant workup is the next step.

Why it matters: Getting the diagnosis right can be the difference between a treatable flareup and a lifethreatening situation. Early, accurate identification guides the right therapy, cuts down complications, and gives you (or a loved one) a clearer roadmap for recovery.

Why Diagnosis Matters

Alcoholic hepatitis isn't just another liver warningit's a signal that the organ is under acute stress from alcohol toxicity. Mortality can spike to 30% within a month for severe cases, but catching it early can lower that risk dramatically.

Knowing the exact stage also tells doctors which treatments actually help. For mild disease, abstinence and nutrition may be enough. For severe disease, steroids or a transplant evaluation might be lifesaving. It's a balance of benefits (recovery, symptom relief) and risks (steroid sideeffects, infections).

Recognizing Symptoms

Most people think "I only feel a little tired," but alcoholic hepatitis often shows up abruptly:

• Jaundice: Yellowing of skin and eyes that appears within weeks of heavy drinking.
• Rightupperquadrant pain: That dull ache near your ribs.
• Fever & chills: Your body's alarm system kicking in.
• Fatigue & loss of appetite: You might feel "real messy," and meals become a chore.
• Encephalopathy: Confusion or sluggish thinking in the worst cases.

Even subtler clueslike spider angiomas, swelling (ascites), or peripheral neuropathycan point toward alcoholic liver damage. Imagine John, a 45yearold who thought his constant tiredness was just stress. One morning his eyes turned yellow, and a quick checkup revealed the classic lab pattern. That early flag saved him from a much harsher trajectory.

StepbyStep Diagnostic Workup

History & Physical

First up, doctors ask the hard questions: "How many drinks per day?" and "How long have you been drinking?" Tools like the AUDITC questionnaire help quantify risk. A thorough physical exam looks for jaundice, spider veins, and fluid buildup.

Lab Panel

The blood work is the real detective here:

• AST>ALT ratio>1.5: A hallmark of alcoholic injury.
• Bilirubin: Elevated levels signal how badly the liver's clearing yellow pigments.
• INR & Albumin: Gauge clotting ability and protein synthesis.
• Complete blood count: Checks for anemia or infection.
• Biomarkers: Tests like ethyl glucuronide (EtG) or phosphatidylethanol (PEth) can confirm recent alcohol intake (according to AAFP research).

Imaging & Ancillary Tests

Ultrasound is usually the first scanquick, cheap, and good at ruling out gallstones or bile duct blockages. If the picture isn't clear, CT or MRI might be ordered to check for complications like necrosis.

Scoring for Severity

Severity scores turn numbers into treatment decisions. Below is a quick reference you can keep on hand.

Score	Components	Severe Threshold	Clinical Action
Maddrey Discriminant Function	Bilirubin+PT	32	Consider steroids
MELD / MELDNa	Bilirubin, Creatinine, INR, Sodium	21	Transplant evaluation
Lille Score	Day0 & Day7 labs after steroids	0.45 (nonresponders)	Stop steroids
ChildPugh	Ascites, Encephalopathy, Bilirubin, Albumin, INR	ClassC	Prognosis, transplant list

These tools let doctors predict who will benefit from aggressive therapy and who might need early transplant referral. Combining MELD with Lille, for example, improves survival predictions (as highlighted in a StatPearls 2025 chapter).

Ruling Out Other Causes

Not every jaundiced, tired person has alcoholic hepatitis. Doctors must exclude:

• Viral hepatitis (HBV, HCV): PCR tests for viral DNA/RNA.
• Autoimmune hepatitis: ANA, SMA, and IgG levels.
• Druginduced liver injury: Review medications, herbal supplements.
• Metabolic disorders: Iron studies for hemochromatosis, ceruloplasmin for Wilson's disease, alpha1antitrypsin levels.

Think of it like a detective narrowing suspectseach test eliminates a possibility until alcoholic hepatitis stands out as the main culprit.

Treatment Pathways

Immediate Management

First and foremost: stop drinking. It sounds simple, but the reality can feel like climbing a steep hill. Counseling, support groups, and medications such as acamprosate or naltrexone raise the odds of staying sober.

Nutrition is another cornerstone. Patients often need 3540kcal/kg daily and 1.21.5g protein/kg to halt muscle loss and support liver repair. A dietitian can craft a plan that feels doablethink hearty soups, lean proteins, and whole grains.

Pharmacologic Options

Medication	When Used	Dosage	Duration	Key Safety Note
Prednisone (or Prednisolone)	Severe disease (MDF32)	40mg oral daily	28days, then taper	Stop if Lille0.45 (nonresponder)
Nacetylcysteine (Adjunct)	Severe cases receiving steroids	40mg IV5days		No proven mortality benefit, but may improve liver function
Pentoxifylline	Previously used for severe cases			Not recommended today (lack of efficacy)

Steroids can cut 30day mortality when patients respond, but they carry infection risk, especially if you have uncontrolled diabetes or an active GI bleed. That's why the Lille score is essentialif you don't respond, it's safer to stop the drugs.

When Steroids Aren't Right

If you have an active infection, uncontrolled blood sugar, or recent bleeding, steroids could do more harm than good. In those cases, the focus shifts to intensive nutrition, careful monitoring, and possibly early transplant evaluationyes, the "sixmonth sobriety rule" is being reconsidered for lifethreatening alcoholic hepatitis (AAFP earlytransplant algorithm).

Lifestyle & Followup

Recovery doesn't end when the lab values improve. Ongoing care is key:

• AUD therapy: Join a support program, consider medicationassisted treatment, and keep a "drinks diary."
• Lab monitoring: Repeat MELD, INR, and bilirubin every 12weeks for the first month, then monthly.
• Imaging: Ultrasound every six months to watch for hepatocellular carcinoma if cirrhosis has set in.
• Patient checklist: Bring these questions to your doctor"What's my current MELD score?" "Do I need a repeat liver biopsy?" "When should I consider transplant evaluation?"

Think of followup as a GPS navigation system. It keeps you on the right route, rerouting when obstacles appear.

Conclusion

In a nutshell, diagnosing alcoholic hepatitis hinges on three pillars: a solid drinking history, a telltale lab pattern, and the right severity scores. Those clues guide whether you need steroids, a nutrition boost, or a transplant workup. Early detection can dramatically improve outcomes, but the benefits must be weighed against potential risks like infections or steroid sideeffects. If you suspect you or someone you love is dealing with alcoholic hepatitis, reach out to a healthcare professional right awaytimely action can truly change the story.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.