A 42-year-old man presents with 2 weeks of jaundice, fever, and tender hepatomegaly after heavy alcohol intake. Bilirubin 12 mg/dL, AST 180 U/L, ALT 70 U/L, prothrombin time 20 seconds (control 12 seconds), creatinine 0.9 mg/dL, no encephalopathy. Which is the most appropriate next step?
- A Abstinence support alone with nutritional supplementation
- B Pentoxifylline 400 mg three times daily
- C Prednisolone 40 mg daily for 28 days ✓
- D Ursodeoxycholic acid 300 mg twice daily
Correct answer: C. Prednisolone 40 mg daily for 28 days
Explanation
The Maddrey discriminant function is 4.6 x (patient PT minus control PT) plus bilirubin in mg/dL, here 4.6 x 8 plus 12, which equals 48.8. C value above 32 defines severe alcoholic hepatitis with roughly 30 to 50 percent short-term mortality, and prednisolone 40 mg daily for 28 days improves survival in such patients. Pentoxifylline failed to show benefit over placebo in the STOPAH trial. UDCA has no role in alcoholic hepatitis.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.