Hepatology

GAHS (Glasgow Alcoholic Hepatitis Score) Calculator

Prognosis of alcoholic hepatitis and selection for steroid therapy

Primary source: Forrest EH et al. Gut 2008; 57(5): 598-603

Aleksandr A. Aulov, MD, internal medicine Last clinical review: April 28, 2026

Online calculation

Age

White blood cell count

Urea

Ratio of patient's PT to upper limit of normal PT

Patient PT / laboratory upper limit of normal PT

Total bilirubin

About this score

Glasgow Alcoholic Hepatitis Score (GAHS, Forrest EH, et al., Gut 2005) is an alternative severity scale for acute alcoholic hepatitis. It uses 5 parameters — age, white blood cell count, urea, PT ratio and bilirubin — each scored 1–3 points, for a total of 5–12.

Interpretation: GAHS ≥ 9 indicates severe hepatitis, with approximately 50% 28-day mortality without treatment, and an indication for corticosteroids; GAHS < 9 indicates supportive care is appropriate. Advantage over Maddrey: it incorporates leukocytosis (reflecting systemic inflammatory response) and urea (an indirect marker of renal function).

Validation data show that GAHS has greater sensitivity for identifying patients who truly benefit from corticosteroids. Guidelines on alcoholic hepatitis recognize GAHS as an alternative to Maddrey. In practice, many centers use both scales in parallel.

When to use

Confirmed or clinically probable acute alcoholic hepatitis.
Decision on corticosteroid therapy, particularly with a borderline Maddrey score.
Predicting 28-day and 84-day mortality.
Parallel assessment alongside Maddrey and MELD to triangulate the treatment decision.

Clinical example

Case

52-year-old man with severe alcoholic hepatitis. WBC 18×10⁹/L, urea 9 mmol/L, PT ratio 1.8, bilirubin 220 µmol/L.

Calculation

Age ≥ 50 (2) + WBC ≥ 15 (3) + urea ≥ 5 (2) + PT ratio 1.5–2.0 (2) + bilirubin 125–250 (2) = 11.

Interpretation and management

GAHS ≥ 9 — severe disease, approximately 50% 28-day mortality. Indication for corticosteroids (prednisolone 40 mg/day × 28 days with Lille score assessment on day 7). In parallel: treatment of alcohol use disorder, nutritional support, and infection prophylaxis.

Limitations and cautions

Less widely used than Maddrey — some clinicians are unfamiliar with it.
Does not directly assess renal function (only urea).
Parameter categories are somewhat coarse — borderline values may change the outcome.
Not validated in patients with severe CKD.

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Frequently asked questions

GAHS vs Maddrey — which is better?

Validation data suggest GAHS better identifies patients who benefit from corticosteroids. However, Maddrey is simpler and historically the standard. Many centers use both.

What does "PT ratio" mean?

The ratio of the patient's PT to control PT. If your laboratory reports INR, it can be used as an approximate substitute.

At what score should corticosteroids be started?

GAHS ≥ 9 is the standard threshold, applied after excluding contraindications (infection, bleeding, severe CKD).

Is it applicable in chronic hepatitis without an acute flare?

No. GAHS was developed for acute episodes of alcoholic hepatitis. For chronic assessment, use Child-Pugh or MELD.

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Aleksandr A. Aulov Physician, internal medicine, Sechenov School — independent medical education platform. Calculators are compiled from the original publications and current clinical guidelines. Interpretation thresholds follow the source study unless stated otherwise.

This calculator is intended for healthcare professionals. Do not use it for self-diagnosis or self-treatment. Management decisions are made by the treating clinician based on the full clinical picture of the individual patient.