Healthcare & Clinical
Maddrey Discriminant Function (mDF) Score for Alcoholic Hepatitis
Calculate Willis Maddrey’s modified Discriminant Function mDF = 4.6 * (PT_patient - PT_control) + Bilirubin_mg_dL to identify severe alcoholic hepatitis (mDF >= 32) eligible for prednisolone therapy.
Why mDF >= 32 has anchored AASLD & EASL severe alcoholic hepatitis guidelines for over 45 years!
Willis C. Maddrey et al. (Gastroenterology, 1978; modified 1989) derived a simple bedside linear discriminant combining coagulopathy and cholestasis—mDF = 4.6 * (PT_patient_sec - PT_control_sec) + Total_Bilirubin_mg_dL—to separate mild self-limiting alcoholic hepatitis (< 10% 28-day mortality when mDF < 32) from severe alcoholic hepatitis (30–50% untreated 28-day mortality when mDF >= 32), where a 28-day prednisolone course (evaluated at Day 7 via the Lille score) confers survival benefit in the absence of active infection or GI bleed!
For an admitted patient with prothrombin time PT = 19.8 s (lab control PT = 12.0 s, prolongation +7.8 s) and serum total bilirubin = 8.4 mg/dL (divide μmol/L by 17.1 if needed), mDF = 4.6 * 7.8 + 8.4 = 44.28 >= 32 ("Severe Alcoholic Hepatitis (mDF >= 32 — Evaluate Steroids)")!
| Clinical Presentation (PT Control = 12.0 s) | mDF Score | 28-Day Prognostic Stratum | AASLD / EASL Pathway |
|---|---|---|---|
| PT = 13.5 s, Bilirubin = 4.2 mg/dL | 11.10 (< 32) | Non-Severe Alcoholic Hepatitis | Supportive Nutrition & Abstinence |
| PT = 19.8 s, Bilirubin = 8.4 mg/dL | 44.28 (>= 32) | Severe Alcoholic Hepatitis | Screen Infection -> Prednisolone + Day-7 Lille |
| Invalid Lab Values (PT <= 0 or Bili < 0) | Error Guard | "Invalid Coagulation / Bilirubin Inputs" | Verify Units (mg/dL vs μmol/L) |
Modified Maddrey Discriminant Function (mDF)
Computes 4.6 * (Patient_PT - Control_PT) + Total_Bilirubin_mg_dL from cells B2, B3, and B4.
=IF(OR(B2 <= 0, B3 <= 0, B4 < 0), "Invalid Lab Inputs", ROUND(4.6 * (B2 - B3) + B4, 2))mDF >= 32 Corticosteroid Eligibility Stratum
Classifies alcoholic hepatitis severity around the guideline-validated mDF = 32 cutoff.
=IF(OR(B2 <= 0, B3 <= 0, B4 < 0), "Invalid Lab Inputs", IF(4.6 * (B2 - B3) + B4 >= 32, "Severe Alcoholic Hepatitis (mDF >= 32)", "Non-Severe (mDF < 32 — Supportive Care)"))Try the example
Use the original values or change them to test your understanding.