Hepatology
Glasgow Alcoholic Hepatitis (GAHS)
Prognosis in alcoholic hepatitis (GAHS).
Education and reference only. Not a substitute for clinical judgement, local policy or product labelling. Always verify before clinical use. Values are calculated in your browser and never stored.
Background
The Glasgow Alcoholic Hepatitis Score (GAHS) predicts short-term mortality in alcoholic (alcohol-related) hepatitis and helps decide who may benefit from corticosteroid treatment. It uses five readily available variables — age, white cell count, urea, INR (prothrombin ratio) and bilirubin — each scored 1–3 depending on thresholds, giving a total of 5 to 12. The variables reflect the severity of liver dysfunction, the systemic inflammatory response and renal involvement. It is typically applied to patients already identified as having severe alcoholic hepatitis, often alongside Maddrey's discriminant function.
Interpreting the result
A score of 5–8 indicates a relatively lower mortality risk, while 9–12 identifies a poorer prognosis and is the group in whom corticosteroids are most likely to improve survival. In patients with a high Maddrey's discriminant function, those with a GAHS of 9 or more have substantially better survival with steroids than without, whereas those scoring 8 or below show little difference. The score therefore helps target steroids to patients most likely to benefit while sparing others their risks.
Advice
A GAHS ≥9 indicates poorer prognosis; steroid decisions are specialist-led, weighing infection and bleeding risk and using it with Maddrey's DF.
Worked example
A patient aged over 50 (2) with a white cell count above 15 (2), urea above 5 mmol/L (2), an INR between 1.5 and 2.0 (2) and bilirubin above 250 µmol/L (3) scores 11. This is a high-mortality group in whom specialist-led corticosteroid therapy is likely to be considered, after assessing for infection and bleeding.
Pearls / pitfalls
- It is prognostic and treatment-targeting, not diagnostic — confirm the clinical diagnosis of alcoholic hepatitis first.
- Steroid decisions are specialist-led and must weigh active infection, gastrointestinal bleeding and uncontrolled diabetes, which may contraindicate steroids.
- Use it alongside Maddrey's discriminant function and MELD rather than in isolation; the scores complement one another.
- Exclude and treat sepsis before starting steroids, and reassess response (for example with the Lille model) during treatment.
Evidence & validation
Derived and validated by Forrest and colleagues in 2005, the GAHS predicted 28- and 84-day mortality more accurately than the discriminant function in their cohorts and identified a steroid-responsive subgroup. It is used in hepatology to support, alongside the discriminant function and MELD, decisions about corticosteroid therapy in severe alcoholic hepatitis.
Frequently asked questions
What GAHS score indicates a poor prognosis?
A score of 9 or more identifies a poorer prognosis and the group most likely to benefit from corticosteroids. Scores of 5–8 carry a comparatively lower mortality risk.
Does a high GAHS mean steroids should always be given?
No. It identifies patients likely to benefit, but the decision is specialist-led and depends on excluding contraindications such as active infection or bleeding. The score supports, not replaces, judgement.
How does GAHS relate to Maddrey's discriminant function?
They are complementary. The discriminant function defines severe disease, and within that group the GAHS helps pick out those who gain most from steroids, so they are often used together.
Which variables make up the GAHS?
Age, white cell count, urea, INR and bilirubin, each scored 1–3 by threshold. These reflect liver dysfunction, systemic inflammation and renal involvement.
What must be excluded before starting steroids?
Active infection and gastrointestinal bleeding in particular, as steroids can worsen them, along with consideration of uncontrolled diabetes. Sepsis should be treated first and response reassessed during therapy.
References
- Forrest EH, Evans CDJ, Stewart S, et al. Analysis of factors predictive of mortality in alcoholic hepatitis and derivation and validation of the Glasgow alcoholic hepatitis score. Gut. 2005;54(8):1174–1179.
- EASL Clinical Practice Guidelines: Management of alcohol-related liver disease. J Hepatol. 2018.
About the creator
Forrest EH et al.
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