Diagnostic criteria

Jaundice onset within previous 8 weeks

Long-term consumption of alcohol: > 40 g (roughly 3 standard drinks) daily for women or > 60 g (roughly 4 standard drinks) daily for men for ≥ 6 months, with < 60 days of abstinence before onset of jaundice

AST > 50 U per L (0.83 μkat per L), AST/ALT ratio > 1.5, and both AST and ALT < 400 U per L (6.68 μkat per L)

Total bilirubin > 3 mg per dL (51.31 μmol per L)

Absence of confounding factors

Confounding factors

Possible ischemic hepatitis (suggested by severe upper gastrointestinal tract bleed, hypotension, cocaine use within seven days of symptom onset)

Possible metabolic liver disease (Wilson disease, alpha1-antitrypsin deficiency)

Possible drug-induced liver disease (use of offending drug within 30 days of jaundice onset)

Uncertain alcohol use assessment (patient denies excessive alcohol use)

Atypical laboratory findings (AST < 50 U per L or > 400 U per L, AST/ALT ratio < 1.5, antinuclear antibodies > 1: 160, or anti–smooth muscle antibodies > 1: 80)

If diagnostic confirmation would change management in the presence of confounding factors, perform liver biopsy