Severe Alcoholic Hepatitis — RACP Adult Medicine MCQ

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ModerateGastroenterology & HepatologySevere Alcoholic HepatitisRACP Adult Medicine

A 55-year-old man with a history of excessive alcohol intake presents with tender hepatomegaly, jaundice, and ascites. His AST is 280 U/L, ALT is 95 U/L (AST:ALT ratio >2:1), bilirubin is 180 µmol/L, and WCC is 16 × 10⁹/L. Discriminant function is 42. What treatment improves short-term survival?

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Correct answer: D — Prednisolone 40 mg daily for 28 days

Severe alcoholic hepatitis (Maddrey discriminant function ≥32 or MELD ≥21) is associated with high short-term mortality (30–50% at 30 days). Prednisolone 40 mg daily for 28 days improves 28-day survival (STOPAH trial). Response is assessed at day 7 using the Lille score – non-responders (Lille >0.45) should have prednisolone ceased. Infection must be excluded before starting steroids. Pentoxifylline is no longer recommended (STOPAH trial showed no benefit). N-acetylcysteine may provide additional benefit when combined with prednisolone.

Reference: eTG – 2025 – Gastrointestinal; EASL – 2018 – Alcoholic Liver Disease Guidelines