10. Women with ALD were generally of higher age and body mass
index, more likely to smoke cigarettes during pregnancy and to
have a low socio-economic status.
They had an increased risk of very preterm birth. Infants of were
at increased risk for low Apgar scores (<7) at 5 min.
Similar associations with slightly lower-risk estimates were found
among women diagnosed with ALD after birth.
Mothers with Alcoholic Liver Disease and the Risk for Preterm and Small-for-
gestational-age Birth. Alcohol and Alcoholism 2013;48:166–171.
Pregnancy, Alcohol and fetus
43. Illness severity and risk of poor
outcome in alcoholic hepatitis
• Maddrey discriminant function (MDF): based
on PT and bilirubin: greater than 32 indicate
severe disease; 30-day mortality
approximately 50%
• Combined Clinical and Laboratory Index
• Model for end-stage liver disease (MELD)
score
• Glasgow alcoholic hepatitis score (GAHS)
• Asymmetric dimethylarginine (ADMA) score
44. Treatment of Acute Alcoholic Hepatitis
With Prednisolone ± N-Acetyl Cysteine
Nguyen-Khac E, et al. AASLD 2009. Abstract 91.
Prednisolone 40 mg/day for 28 days +
NAC IV on Days 1-5*
(n = 85)
Prednisolone 40 mg/day for 28 days +
5% Glucose (Carrier) IV on Days 1-5
(n = 89)
Pts with
acute alcoholic
hepatitis
(N = 174)
Follow-up:
Mos 1, 2, 3, 6
Stratified by center
*Day 1 NAC: 150 mg/kg in 250 mL 5% glucose over 15 mins; 50 mg/kg in 500 mL 5% glucose over 4 hrs;
100 mg/kg in 1000 mL 5% glucose over 16 hrs. Days 2-5 NAC: 100 mg/kg in 1000 mL 5% glucose.
Mortality, % Prednisolone + NAC
(n = 85)
Prednisolone + Carrier
(n = 89)
P Value
Mo 6 (primary endpoint) 27.1 38.2 .117
Mo 1 8.2 23.6 .005
Mo 2 15.3 32.6 .007
Mo 3 22.4 33.7 .095
N Engl J Med 2011;365:1781-9.
