How it's calculated
5 parameters — age, white cell count, urea, PT ratio (or INR), and bilirubin — are each scored 1 to 3 points and summed for a total ranging from 5 to 12.
Score interpretation
| Score | Interpretation |
|---|---|
| < 9 | Lower-risk score |
| ≥ 9 | Poor prognosis — significantly higher 28-day and 84-day mortality |
Clinical use
- Used alongside Maddrey's Discriminant Function to help decide whether corticosteroid therapy is likely to be beneficial in severe alcoholic hepatitis — the original validation found GAHS discriminated survival better than Maddrey's DF alone, including in patients already started on steroids.
- Unlike Maddrey's DF (calculated once at presentation), GAHS can be recalculated after a few days of treatment to reassess prognosis.
- A high score (≥9) supports a more guarded prognosis discussion and closer monitoring, but the decision to start/continue steroids should still follow local hepatology protocol and involves other factors (e.g. active infection, GI bleeding, renal failure).
Frequently asked questions
What does the Glasgow Alcoholic Hepatitis Score predict?
28-day and 84-day survival in patients with alcoholic hepatitis — a score of 9 or more identifies a significantly worse prognosis.
How is GAHS different from Maddrey's Discriminant Function?
Both assess severity/prognosis in alcoholic hepatitis, but use different criteria — Maddrey's DF is a continuous formula based on prothrombin time and bilirubin, while GAHS is a 5-component point score (age, WBC, urea, PT ratio, bilirubin) that in its validation study better discriminated survival, including in steroid-treated patients.
Can GAHS be recalculated during treatment?
Yes — unlike some one-off admission scores, GAHS can be reassessed after a few days of therapy to help gauge response and refine the prognosis discussion.
References
- Forrest EH, 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.