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Minerva Medica 2017 Nov 07

DOI: 10.23736/S0026-4806.17.05431-3

Copyright © 2017 EDIZIONI MINERVA MEDICA

lingua: Inglese

Acute alcoholic hepatitis: a literature review and proposal of treatment

Gianni TESTINO , Silvia LEONE

Alcohological Regional Centre, Ligurian Region, ASL 3 Genovese presso Ospedale Policlinico San Martino, Genoa, Italy


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Severe acute alcoholic hepatitis (AAH) can lead to a clinical picture with a sixmonth mortality rate in more than 70% of cases. This clinical picture is characterized by: jaundice with a duration of less than three months, jaundice at the first failure event, serum bilirubin greater than 5 mg / dL, ratio AST / ALT> 2: 1, AST less than 500 IU / L, ALT <300 IU / L, neutrophil leukocytosis and a GGT increase. In addition, encephalopathy, fever, asthenia and coagulopathy may be present. Its onset may also be characterized by portalhypertensionrelated complications, particularly bleeding and hepatorenal syndrome. In cases where there is an overlapping of an acute form characterized by an etiological factor other than that of the base hepatopathy, acute on chronic liver failure (ACLF) is obtained. This can result in systemic inflammation response syndrome (SIRS) with a multiorgan systemic involvement. Several indices are used to evaluate the prognosis, in particular the Maddrey Discriminant Function (mDF) and the MELD (Model of End Stage Liver Disease). In our clinical practice, we use the MELD routinely. In cases of ACLF, a consortium organ failure score (CLIFCOFs) is used. Therapy is characterized by abstention in cases of severe forms (mDF> 32 and MELD> 21); in the absence of contraindications, steroid therapy is possible. In cases of an unresponsive liver, transplantation is premature. In our view, this possibility, after proper selection, must be offered for both prognostic and ethical reasons.


KEY WORDS: Alcohol - Acute on chronic liver failure - Acute alcoholic hepatitis - Liver transplantation

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Publication History

Article first published online: November 7, 2017
Manuscript accepted: November 6, 2017
Manuscript received: September 18, 2017

Per citare questo articolo

Testino G, Leone S. Acute alcoholic hepatitis: a literature review and proposal of treatment. Minerva Med 2017 Nov 07. DOI: 10.23736/S0026-4806.17.05431-3

Corresponding author e-mail

gianni.testino@hsanmartino.it