Treatment of Alchololic-associated hepatitis

• consider if MDF ≥32, MELD >18, or presence of encephalopathy

• Glucocorticoids (eg, methylprednisolone 32 mg/d or prednisolone 40 mg/d × 4 wk → 4–6 wk taper) may ↓ 1-mo but not 6-mo mortality, a/w ↑ infection (NEJM 2015;372:1619, CD001511)

The use of glucocorticoids, such as methylprednisolone 32 mg per day or prednisolone 40 mg per day for four weeks followed by a taper over 4-6 weeks, may decrease the one-month mortality rate but not the six-month mortality rate. However, it is associated with an increased risk of infection

• Contraindic: active GIB, pancreatitis, untreated HBV, uncontrolled bact/fungal/TB infxn

• Addition of NAC to steroids ↓ 1-mo but not 6-mo mortality (NEJM 2011;365:1781)