Table 1.

Diagnosis of Alcoholic Hepatitis [Adapted from (12, 14)]

Definite	Probable	Possible
Clinical features: AST >50, AST/ALT >1.5, and both values < 400IU/L Ongoing consumption of >40 (female) or 60 (male) g alcohol/day for ≥6 months, with <60 days of abstinence before the onset of jaundice Onset of jaundice within the prior 8 weeks Total bilirubin >3.0 mg/dL Biopsy features: Hallmarks include neutrophilic lobular inflammation, degenerative changes in hepatocytes (ballooning and Mallory-Denk inclusions), steatosis, and pericellular fibrosis Underlying cirrhosis present in 30-40% of patients	Clinically diagnosed without the presence of the following confounding factors: Atypical laboratory tests (e.g., AST <50 or >400 IU/L, AST/ALT <1.5), ANA >1:160 or SMA >1:80 Possible drug-induced liver disease (suspect drug taken within 30 days of onset of jaundice) Possible ischemic hepatitis (e.g., severe upper gastrointestinal hemorrhage, hypotension, or cocaine use within 7 days) or metabolic liver disease (Wilson disease, alpha-1 antitrypsin deficiency) Uncertainties about alcohol use assessment (e.g., patient denies excessive alcohol use)	Clinically diagnosed with one or more of the following confounding factors present: Atypical laboratory tests (e.g., AST <50 or >400 IU/L, AST/ALT <1.5), ANA >1:160 or SMA >1:80 Possible drug-induced liver disease (suspect drug taken within 30 days of onset of jaundice) Possible ischemic hepatitis (e.g., severe upper gastrointestinal hemorrhage, hypotension, or cocaine use within 7 days) or metabolic liver disease (Wilson disease, alpha-1 antitrypsin deficiency) Uncertainties about alcohol use assessment (e.g., patient denies excessive alcohol use)

ALT=alanine aminotransferase; ANA=anti-nuclear antibody; AST=aspartate aminotransferase; SMA=smooth muscle antibody