Maddrey's Discriminant Function Calculator for Alcoholic Hepatitis
Maddrey's Discriminant Function Calculator
Calculate the MDF score to assess the severity of alcoholic hepatitis
What is Maddrey's Discriminant Function?
Maddrey's Discriminant Function (MDF) is a widely used scoring system to assess the severity of alcoholic hepatitis. It helps clinicians determine the prognosis and guide treatment decisions, particularly regarding the use of corticosteroids.
Formula
The formula for calculating Maddrey's Discriminant Function is:
MDF = 4.6 × (Patient PT - Control PT) + Total Bilirubin (mg/dL)
Where:
- PT = Prothrombin Time (in seconds)
- Total Bilirubin is measured in mg/dL
Interpretation
The interpretation of the Maddrey's Discriminant Function score:
- MDF ≥ 32: Indicates severe alcoholic hepatitis with high short-term mortality (approximately 30-50% at 1 month). Patients with this score are typically considered for corticosteroid or pentoxifylline treatment.
- MDF < 32: Indicates less severe alcoholic hepatitis with lower short-term mortality. These patients are usually managed with supportive care.
Clinical Use
Maddrey's Discriminant Function is used to:
- Assess the severity of alcoholic hepatitis
- Predict short-term mortality risk
- Guide treatment decisions, particularly regarding the use of corticosteroids
- Monitor response to treatment
Limitations
While widely used, Maddrey's Discriminant Function has some limitations:
- It does not account for other factors that may affect prognosis, such as renal function, age, or presence of infection
- Other scoring systems like MELD (Model for End-Stage Liver Disease), GAHS (Glasgow Alcoholic Hepatitis Score), and Lille score may provide additional prognostic information
- The control PT can vary between laboratories, which may affect the calculation
References
- Maddrey WC, et al. Corticosteroid therapy of alcoholic hepatitis. Gastroenterology. 1978;75(2):193-199.
- Carithers RL Jr, et al. Methylprednisolone therapy in patients with severe alcoholic hepatitis. A randomized multicenter trial. Ann Intern Med. 1989;110(9):685-690.
- 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.