Maddrey Discriminant Function
Estimates disease severity and mortality risk in alcoholic hepatitis.
The Maddrey Score: Evaluating Alcoholic Hepatitis
The Maddrey Discriminant Function (mDF) was first described in 1978. It is a major prognostic tool used in hepatology to assess the severity of acute alcoholic hepatitis and guide therapeutic decisions, particularly the use of corticosteroids.
How is the score calculated?
The original formula is simple yet highly effective. It relies on two essential laboratory parameters reflecting hepatic synthesis and excretory function:
- Prothrombin Time (PT) Prolongation: (Patient PT in seconds - Control PT in seconds) × 4.6
- Total Bilirubin: Added in mg/dL.
- Formula: mDF = 4.6 x (Patient PT - Control PT) + Bilirubin (mg/dL)
Therapeutic Indications
A Maddrey score ≥ 32 indicates severe alcoholic hepatitis with a very high 1-month mortality risk (30% to 50% without treatment). In these patients, corticosteroid therapy (e.g., Prednisolone 40 mg/day for 28 days) is indicated, provided there are no major contraindications (active uncontrolled infection, active GI bleeding, severe renal failure).
Interpretation of Maddrey Function
| Score (mDF) | Severity | Management |
|---|---|---|
| < 32 | Non-Severe | Supportive care, abstinence, nutrition. |
| ≥ 32 | Severe | Corticosteroids (if not contraindicated). |
References:
1. Maddrey WC, Boitnott JK, Bedine MS, et al. Corticosteroid therapy of alcoholic hepatitis. Gastroenterology. 1978;75(2):193-199.
[Gastroenterology Journal]
2. Mathurin P, et al. Corticosteroids improve short-term survival in patients with severe alcoholic hepatitis: meta-analysis of individual patient data. Gut. 2011;60(2):255-260.
[Gut Journal]
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