Question 1

How does GAHS differ from the Maddrey DF?

Accepted Answer

The Maddrey DF uses only PT and bilirubin and has a single threshold (DF ≥ 32) to define severity. GAHS incorporates additional parameters (age, WBC, urea) and provides graded risk stratification. GAHS may be more accurate in predicting mortality in the intermediate-risk group. Many centres use both scores in parallel.

Question 2

Can GAHS be used in patients with acute-on-chronic liver failure (ACLF) from other aetiologies?

Accepted Answer

GAHS was specifically developed and validated in alcoholic hepatitis. In ACLF from other causes (e.g., viral, ischaemic), use disease-specific scores such as CLIF-SOFA or CLIF-C ACLF score.

Question 3

Should I start steroids based on GAHS alone?

Accepted Answer

No — decisions about corticosteroid therapy should integrate GAHS with the Maddrey DF and the Lille score (to assess response at day 7). Screen for active infection (including SBP) before starting steroids. If infection is present, treat it first before considering corticosteroids.

Question 4

How should I convert BUN to urea?

Accepted Answer

The GAHS uses urea in mmol/L. If you have BUN in mg/dL, divide by 2.14 to convert to urea in mmol/L. Most laboratories report urea directly (not BUN) outside the United States.