Alcohol-related hepatitis: A review article

Table 1 Histological differences between non-alcoholic steatohepatitis and alcohol-related hepatitis

Histological features	NASH	ARH
Canalicular cholestasis	Less common	More common
Mallory denk body	Less common	More common
Ductular reaction	Less common	More common
Fibrosis in portal tract	Less common	More common
Sclerosing hyaline necrosis	Less common	More common
Veno-occlusive lesions	Less common	More common
Severe steatosis	More common	Less common
Glycogenated nuclei	More common	Less common
Lipogranulomas	More common	Less common
Fibrosis	Lattice pattern	Solid pattern

NASH: Non-alcoholic steatohepatitis; ARH: Alcohol-related hepatitis.

Table 2 Prediction models for alcohol-related hepatitis

Score	Variables	Mortality rate
MDF	PT, total bilirubin	50% at 30 d for score ≥ 32
Lille model	Age, albumin, change in total bilirubin, renal insufficiency, MDF score	75% at 6 mo for score ≥ 0.45
Model for end-stage liver disease	Creatinine, total bilirubin, INR	20% at 90 d for score > 21
Glasgow alcoholic hepatitis score	Age, white blood cell count, BUN, total bilirubin, PT	48% at 28 d for score ≥ 9
ABIC score	Age, total bilirubin, creatinine, INR	75% at 90 d for score > 9

PT: Prothrombin time; BUN: Blood urea nitrogen; INR: International normalized ratio; ABIC: Age, serum bilirubin, international normalized ratio, serum creatinine; MDF: Maddrey discriminant function.

Table 3 Clinical trials under investigation

Drugs	Mechanisms	Clinical trials
Anakinra and Canakinumab	Reduce hepatic inflammation	NCT01809132[121], NCT04072822[122], NCT03775109[123]
N-acetyl cysteine, S-adenosyl methionine (SAM-E)	Reduce oxidative stress	NCT03069300[124], NCT00851981[125], NCT02024295[126]
DUR-928	Epigenetic modulation of lipid homeostasis, inflammation, cell survival, tissue regeneration	NCT03432260[127], NCT03917407[128]
Granulocyte colony stimulating growth factors, interleukin-22 and obeticholic acid	Boosts liver regeneration	NCT02442180[129], NCT03703674[130], NCT04066179[131], NCT02655510[132], NCT01918462[133], NCT02039219[134]
Rifaximin, zinc supplementation, bovine colostrum, probiotics, and fecal microbiota transplant	Targets the gut-liver axis	NCT02116556[135], NCT02485106[136], NCT01968382[137], NCT02473341[138], NCT01922895[139], NCT02335632[140], NCT02458079[141], NCT03091010[142], NCT03827772[143]