Maddrey discriminant function for alcohol-associated hepatitis

The Maddrey discriminant function (4.6 × [patient PT − control PT] + bilirubin) identifies severe alcohol-associated hepatitis with high short-term mortality.

What goes into the Maddrey discriminant function

Prothrombin time (s)
Control PT (s)
Total bilirubin (mg/dL)

How to interpret the result

≥ 32: severe disease; consider prednisolone 40 mg daily if no contraindication
< 32: supportive care; steroids not indicated

Clinical pearls

MELD > 20 is an alternative threshold for severe disease and predicts mortality better.
In STOPAH, prednisolone gave a short-term (28-day) benefit that did not last to 90 days; pentoxifylline had no benefit.
Use the Lille score on day 4–7 to stop steroids in non-responders.

Evidence

Maddrey WC, et al. Corticosteroid therapy of alcoholic hepatitis. Gastroenterology. 1978;75:193-199.

Related workups

Alcohol-associated hepatitis Decompensated cirrhosis (ascites, SBP, hepatic encephalopathy)

Related calculators

MELD 3.0 and MELD-Na Child-Pugh score All calculators

For education only. Check the inputs and the population the score was validated in before acting on it. Not a substitute for clinical judgment.