Hepatology
Maddrey’s Discriminant Function
Maddrey DF is a prognostic index for alcoholic hepatitis. Enter prothrombin time (patient and control) and serum bilirubin to calculate the score and determine severity.
Use mean control PT from your lab (typically ~12 seconds).
Inputs
- Patient PT: 24
- Control PT: 12
- Bilirubin: 18
Maddrey DF score
73.2
Severe threshold: ≥ 32
Maddrey DF ≥ 32 indicates high short-term mortality. Consider corticosteroid therapy (after excluding infection/GI bleed) or alternative options (pentoxifylline).
Use Lille score after 7 days of corticosteroids to assess treatment response.
How to Use This Calculator
Collect baseline labs
Use prothrombin time and bilirubin before initiating corticosteroids or pentoxifylline.
Enter lab values accurately
Use the same lab’s control PT. If INR is available instead, convert PT or use alternative severity scores (e.g., MELD).
Interpret and act
Maddrey DF ≥ 32 → initiate steroid trial if no contraindications. Reassess with Lille score on day 7 to evaluate response.
Formula
Maddrey DF = 4.6 × (Patient PT − Control PT) + Serum bilirubin (mg/dL)
Severe alcoholic hepatitis defined as DF ≥ 32.
Use alongside MELD score, ABIC score, or Lille score to refine prognosis.
Full Description
Maddrey’s Discriminant Function (1978) stratifies mortality risk in alcoholic hepatitis using coagulopathy and hyperbilirubinemia. Patients with DF ≥ 32 have ~35–45% 28-day mortality without treatment, prompting consideration of corticosteroids or alternative therapies.
Contraindications to steroids include active GI bleeding, uncontrolled infection, or renal failure. Reassess after 7 days (Lille score) to decide whether to continue therapy. Supportive care (nutrition, alcohol abstinence, infection control) remains essential.
Frequently Asked Questions
Can I use INR instead of PT?
Maddrey DF was derived with PT in seconds. If only INR is available, convert to PT using lab-specific formula or use MELD score.
When should I calculate Lille score?
On day 7 of corticosteroid therapy to assess response. Lille > 0.45 indicates poor response; discontinue steroids.
Does pentoxifylline improve outcomes?
Evidence is mixed. It may reduce hepatorenal syndrome risk when steroids are contraindicated but lacks survival benefit.
What supportive measures are critical?
Aggressive nutritional support, infection screening, management of ascites/encephalopathy, and sustained alcohol abstinence programs.