Background <p>Alcohol-related liver disorders (ALD) encompass a wide spectrum, including severe alcoholic hepatitis (AH), alcoholic fibrosis, compensated/decompensated cirrhosis, and steatohepatitis. ALD is responsible for nearly half of all liver cirrhosis-related fatalities worldwide, posing substantial morbidity, mortality, and economic burden. The aim of the study was to correlate histologic and clinical parameters with outcomes and mortality among patients diagnosed with severe alcoholic hepatitis attending a tertiary health center. A retrospective observational study was conducted among 1200 patients diagnosed with alcoholic hepatitis at the Department of Medical Gastroenterology of a tertiary healthcare center; final sample based on the inclusion and exclusion criteria had 100 patients. The demographic, clinical characteristics, laboratory parameters, and alcoholic hepatitis histological scores (AHHS) were obtained from liver biopsies before initiating corticosteroid therapy. Child-Pugh score, Model for End-Stage Liver Disease (MELD) score, modified Maddrey’s discriminant function (MDF), and the AHHS score were used to assess the status of patients.</p> Results <p>A majority of selected patients were male (91%) with ages between 31 and 40 years (46%). Common comorbidity among participants was hypertension (51%), and 89% of patients received corticosteroid treatment, with 58% showing a positive response. The overall survival rate was 72%. We observed a significant association between AHHS score categories and overall survival, with severe AHSS scores linked to increased mortality. We observed a significant reduction and improvement in clinical and laboratory parameters at baseline and follow-up.</p> Conclusions <p>This study highlights the importance of assessing the AHHS score and considering liver biopsy to predict outcomes and tailor treatment approaches in severe alcoholic hepatitis.</p>