Plasma tumor necrosis factor α (TNF α), interleukin 1 α (IL-1α), and interleukin 1 β (IL-1β) were measured in plasma samples obtained from 23 patients with severe alcoholic hepatitis on admission and after 30 days of hospitalization. Over a 2-year follow-up period, 14 patients died at a mean time of 8 months following discharge. The presence of elevated plasma TNF α either at admission or discharge from the hospital was associated with death in 82% (14/17) of patients. By contrast absence of elevated plasma TNF α was associated with survival in 100% (6/6). The difference in survival with and without detectable plasma TNF α was significant at p= 0.0022. Plasma TNF α was not elevated in alcoholic patients without clinically apparent liver disease, with alcoholic cirrhosis, or in nonalcoholic healthy controls. Plasma IL-1a was also significantly increased in alcoholic hepatitis whereas IL-1β was not. Neither IL-1α nor β was correlated with outcome in the alcoholic hepatitis group. It is concluded that the presence of elevated plasma TNF α is a significant predictor of decreased long-term survival in patients with severe alcoholic hepatitis.