sec
sec
mg/dL
How it's calculated
MDF = 4.6 × (patient's PT − control PT, in seconds) + total bilirubin (mg/dL).
Interpretation
| MDF | Severity |
|---|---|
| < 32 | Non-severe — supportive care |
| ≥ 32 | Severe — corticosteroid therapy may be considered |
Clinical use
- Used to grade the severity of alcoholic hepatitis and identify patients who may benefit from corticosteroid therapy (e.g. prednisolone).
- A score of 32 or higher is the traditional threshold for 'severe' disease, associated with substantial short-term mortality if untreated.
- Active infection and gastrointestinal bleeding should be excluded or treated before starting corticosteroids, given their immunosuppressive effect and bleeding risk.
Frequently asked questions
What does a Maddrey's Discriminant Function of 32 or above mean?
It identifies severe alcoholic hepatitis, historically associated with roughly 30-50% one-month mortality without treatment, and is the threshold most commonly used to consider corticosteroid therapy.
What labs do I need for Maddrey's Discriminant Function?
The patient's prothrombin time (PT) in seconds, the laboratory's control PT value, and the total serum bilirubin in mg/dL.
Is Maddrey's score the only tool used for alcoholic hepatitis severity?
No — the Glasgow Alcoholic Hepatitis Score, MELD score, and ABIC score are also used, sometimes in combination, to assess severity and prognosis in alcoholic hepatitis.
References
- Maddrey WC, et al. Corticosteroid therapy of alcoholic hepatitis. Gastroenterology. 1978;75(2):193-199.
- Carithers RL, et al. Methylprednisolone therapy in patients with severe alcoholic hepatitis. Ann Intern Med. 1989.