How do you balance infection risk versus therapeutic benefit of steroid tapers when treating patients with alcohol related hepatitis?

Patients presenting with severe alcoholic hepatitis who are initiated on corticosteroids following exclusion of an active infection and GI bleeding should have a Lille score calculated at day 7, though some centers now use a day-4 Lille score, which has similar prognostic value with regard to response to corticosteroids. Lille responders (<0.45) should continue steroids for 28 days without a taper. There is no current guidance on tapering steroids within the 28-day treatment period. Judicious mo...