Maddrey's Discriminant Function
MDF = 4.6×(PT-Control PT) + Bilirubin. ≥32 = severe alcoholic hepatitis; consider steroids.
Why This Health Metric Matters
Why: MDF stratifies alcoholic hepatitis severity and guides steroid therapy.
How: Combines PT prolongation (synthetic function) with bilirubin (injury).
- ●MDF ≥32: steroids may help
- ●Lille score at day 7 for response
- ●28-day mortality ~35-50% if severe
🏥 Sample Clinical Scenarios
🧪 Laboratory Values
Maddrey's Discriminant Function
Clinical Interpretation
Visual Analysis
MDF Score
Component Contribution
Clinical Recommendations
Step-by-Step Calculation
The Maddrey DF evaluates prognosis in alcoholic hepatitis and guides corticosteroid therapy.
Patient PT: 14 seconds
Control/Reference PT: 12 seconds
PT Difference = 14 - 12 = 2.0 seconds
Bilirubin: 2 mg/dL
MDF = 4.6 × (PT - Control PT) + Bilirubin
MDF = 4.6 × 2.0 + 2.00
MDF = 9.20 + 2.00 = 11.20
Severity: Mild (threshold < 32)
28-Day Mortality Risk: Low (~10%)
Steroid Therapy: Not typically indicated
MDF Interpretation Reference
| MDF Score | Severity | Mortality Risk | Steroid Indication |
|---|---|---|---|
| < 32 | Mild | Low (~10%) | Not typically indicated |
| ≥ 32 | Severe | High (35-50% at 28 days without treatment) | Strongly indicated (if no contraindications) |
Related Scoring Systems for Alcoholic Hepatitis
| Score | Variables | Purpose | Cutoff |
|---|---|---|---|
| Maddrey DF | PT, Bilirubin | Severity & steroid indication | ≥32 = Severe |
| MELD | Bilirubin, Creatinine, INR, Na | Mortality prediction | ≥21 = High mortality |
| Lille | Age, Cr, Albumin, PT, Bili (days 0 & 7) | Steroid response at day 7 | >0.45 = Non-responder |
| Glasgow AH | Age, WBC, Urea, INR, Bilirubin | 28-day mortality | ≥9 = High mortality |
| ABIC | Age, Bilirubin, INR, Creatinine | 90-day mortality | >9 = High risk |
Treatment Algorithm for Severe Alcoholic Hepatitis
Step 1: Calculate MDF
If MDF ≥32, proceed to evaluation for steroids
Step 2: Rule Out Contraindications
Active infection, GI bleeding, renal failure (HRS), pancreatitis, uncontrolled diabetes
Step 3: Start Prednisolone 40mg/day
Or methylprednisolone 32mg/day IV if unable to take PO
Step 4: Calculate Lille Score at Day 7
Lille >0.45 = Non-responder → Stop steroids; Lille ≤0.45 = Continue for 28 days
Steroid Contraindications
- • Active bacterial infection
- • Gastrointestinal bleeding
- • Hepatorenal syndrome (HRS)
- • Acute pancreatitis
- • Uncontrolled diabetes mellitus
Supportive Care
- • Nutritional support (35-40 kcal/kg/day)
- • Thiamine & folate supplementation
- • Abstinence from alcohol (essential)
- • PPI for GI prophylaxis if on steroids
- • Monitor for infections closely
<32
MDF: ~10% 30-day mortality
32-54
MDF: ~35% 30-day mortality
55-80
MDF: ~50% 30-day mortality
>80
MDF: ~70% 30-day mortality
Clinical Disclaimer
The Maddrey Discriminant Function is one of several tools used to assess severity of alcoholic hepatitis. Clinical judgment should incorporate all available data including imaging, clinical trajectory, and patient factors. Treatment decisions should be made by experienced hepatologists.
⚠️For informational purposes only — not medical advice. Consult a healthcare professional before acting on results.
🏥 Health Facts
Steroids contraindicated with infection. Rule out before starting.
— Guidelines
📊 What is Maddrey's Discriminant Function?
Maddrey's Discriminant Function (MDF), also called the Modified Maddrey's Discriminant Function, was developed in 1978 by Maddrey and colleagues to assess severity and prognosis in patients with alcoholic hepatitis.
The score combines prothrombin time prolongation (reflecting synthetic liver function) with bilirubin level (reflecting cholestasis and hepatocyte injury) to stratify patients into those who may benefit from corticosteroid therapy.
Key Components
- Prothrombin Time: Reflects hepatic synthetic function
- Control PT: Laboratory reference value (typically 11-13 seconds)
- Bilirubin: Marker of cholestasis and liver injury
🧮 How to Calculate MDF
- Obtain PT: Patient's prothrombin time in seconds
- Note Control PT: Laboratory reference PT (typically 11-13 seconds)
- Calculate PT Difference: Patient PT minus Control PT
- Obtain Bilirubin: Total serum bilirubin (mg/dL)
- Apply Formula: MDF = 4.6 × (PT - Control PT) + Bilirubin
Maddrey's Formula:
MDF = 4.6 × (Patient PT - Control PT) + Bilirubin (mg/dL)
⏰ When to Use MDF
Clinical Applications
- Assess alcoholic hepatitis severity
- Guide corticosteroid therapy decision
- Predict short-term mortality
- Triage for intensive care
- Baseline for Lille score calculation
Limitations
- Doesn't predict steroid response
- Limited accuracy in mild disease
- Control PT varies between labs
- Doesn't account for infection
- Use Lille score for treatment response
📐 MDF Interpretation
| MDF Score | Severity | 28-Day Mortality | Steroid Therapy |
|---|---|---|---|
| < 32 | Mild | ~10% | Not indicated |
| ≥ 32 | Severe | 35-50% | Indicated (if no contraindications) |
Note: Contraindications to steroids include active infection, GI bleeding, renal failure, and pancreatitis. Consider pentoxifylline as an alternative.
📋 Key Evidence & Treatment Algorithm
Maddrey et al. (1978)
Original study showing steroids improve survival when MDF ≥32
STOPAH Trial (NEJM 2015)
Prednisolone showed 28-day mortality benefit but not 90-day or 1-year; pentoxifylline showed no benefit
Treatment Algorithm
MDF ≥32 → Start prednisolone 40mg/day → Calculate Lille at Day 7 → Continue if Lille <0.45, stop if ≥0.45
Steroid Contraindications
Active infection, uncontrolled GI bleeding, acute pancreatitis, renal failure (consider alternatives)