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Glasgow Alcoholic Hepatitis Score (GAHS)

The Glasgow Alcoholic Hepatitis Score (5–12) uses age, white cell count, urea, PT ratio/INR and bilirubin to predict mortality in alcohol-associated hepatitis. A score ≥9 predicts poor survival and identifies patients who may benefit from corticosteroids.

Age (years)
White blood cell count (×10⁹/L or ×10³/µL)
Urea (or BUN) (mg/dL or mmol/L)
PT ratio or INR
Total bilirubin (mg/dL or µmol/L)

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Interpretation

Result	Meaning
5–8	Better prognosis (28-day survival ~87% in derivation)
9–12	Poor prognosis (28-day survival ~46%)

Formula

Age <50 = 1, ≥50 = 2 · WCC <15 = 1, ≥15 ×10⁹/L = 2 · Urea <5 = 1, ≥5 mmol/L (BUN ≥14 mg/dL) = 2 · PT ratio/INR <1.5 = 1, 1.5–2.0 = 2, >2.0 = 3 · Bilirubin <125 = 1, 125–250 = 2, >250 µmol/L (7.3 / 14.6 mg/dL) = 3

Clinical pearls

Forrest validated the score equally with INR or PT ratio.
Usually applied when Maddrey DF ≥32; GAHS ≥9 identified the subgroup with steroid benefit (Forrest 2007).

Examples

gahs 55 yo wbc 17 urea 7 mmol/L inr 1.8 bili 300 umol/L Glasgow alcoholic hepatitis score: age 42, WBC 9, BUN 10 mg/dL, INR 1.4, bilirubin 6 mg/dL gahs age 48 wcc 16 urea 4 inr 2.3 bili 200 umol/l

FAQ

What GAHS score is severe?

A Glasgow Alcoholic Hepatitis Score of 9 or more indicates poor prognosis.

GAHS vs Maddrey?

In the derivation study GAHS predicted 28-day outcome with 81% accuracy versus 49% for the modified discriminant function.

Evidence

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;54:1174–9.

Hepatology & GI · Reviewed 2026-10-14 · Methodology