A 42-year-old man presents with low-grade fever, anorexia, dark urine, light-colored stools, and right upper quadrant aching discomfort of 2 weeks' duration. He indicates that he has consumed a pint of whiskey daily for the past 10 years and denies use of illicit drugs or exposure to hepatitis. His physical examination reveals sclera icterus, cutaneous jaundice, proximal muscle wasting, asterixis, a palpable liver and spleen, and peripheral edema. Laboratory studies include an aspartate aminotransferase (AST) of 102 IU, a normal alanine aminotransferase (ALT), an elevated alkaline phosphatase, bilirubin of 6.5 mg/dL, and prothrombin time of 19 seconds (control of 12 seconds). On the basis of his history of chronic alcohol consumption, fever, hepatosplenomegaly, cholestasis and an AST/ALT ratio of greater than 2 to 1, you make a presumptive diagnosis of acute alcoholic hepatitis. His Maddrey discriminant function score is 39. What is the best approach to his treatment?
