Maddrey Discriminant Function (alcoholic hepatitis severity)
Severity of acute alcoholic hepatitis based on prothrombin time and bilirubin. A score ≥ 32 indicates severe disease.
About this calculator
Maddrey Discriminant Function (DF, MDF) grades alcoholic hepatitis severity and guides corticosteroid use. Developed by Maddrey (Gastroenterology, 1978). Formula: DF = 4.6 × (patient PT – control PT) + total bilirubin mg/dL. PT in seconds. Interpretation. <32 – mild-to-moderate alcoholic hepatitis, 30-day mortality <10%, no corticosteroids, supportive care, abstinence, nutritional support. >=32 – severe alcoholic hepatitis, 30-day mortality 30-50%, consider prednisolone 40 mg once daily for 28 days with response assessment. Lille score at 7 days. On prednisolone, assess Lille score at 7 days (bilirubin change, creatinine, albumin, PT, age). Lille <0.45 – responder, continue prednisolone to 28 days. Lille >=0.45 – non-responder, stop prednisolone, consider N-acetylcysteine, discuss liver transplantation. Indications and contraindications. Indications: DF >=32, MELD >=21, OR hepatic encephalopathy (HE). Contraindications: active infection (including SBP), active GI bleeding, severe sepsis, hepatorenal syndrome. Mandatory pre-treatment screening for HBV, HCV, HIV, SBP, active TB. AASLD 2024 recommends MELD >=21 as an alternative threshold – some patients with DF<32 and MELD>=21 still benefit from prednisolone. Limitations. Depends on PT lab normalization – varies across labs. Inaccurate on warfarin or in cholestatic disease. MELD-Na and Glasgow Alcoholic Hepatitis Score (GAHS) are more reproducible and preferred by current hepatologists. Prednisolone reduces 28-day mortality by 5-10% (STOPAH, NEJM 2015) but does not affect 90-day or 1-year mortality.
Source
Formula version: maddrey-1978-aasld-2020-v1