𧬠Maddrey's Discriminant Function
Alcoholic hepatitis severity: DF 32 and above means severe.
Educational only. Alcoholic hepatitis management belongs to the treating team.
Severe alcoholic hepatitis kills quickly: 30-day mortality without treatment runs 30-50%. Maddrey's discriminant function, two labs and one multiplication, identifies the severe cases (DF 32 or above) that may benefit from corticosteroids. Enter prothrombin times and bilirubin above.
How to Use This Calculator
Enter the patient's PT, the lab's control PT, and serum bilirubin. The DF and severity appear.
Enter patient PT and control PT in seconds from the same lab.
Enter total bilirubin in mg/dL.
Read the DF: 32+ is severe. Steroid decisions also require infection screening and the Lille score at day 7.
The Formula
Maddrey and colleagues derived it in 1978 to select patients for corticosteroid trials: prolonged PT captures failing hepatic synthetic function, bilirubin captures cholestasis and hepatocellular injury, and the 4.6 coefficient weights the coagulopathy appropriately. The 32 threshold marked the point where short-term mortality justified steroid risks. It has survived nearly five decades because it works with universally available labs and no calculator tricks.
Its companions: the MELD score also predicts mortality in alcoholic hepatitis and some guidelines prefer it; the Glasgow alcoholic hepatitis score adds age, white cells, and urea; the Lille score at day 7 of steroids identifies non-responders who should stop (Lille >0.45 means stop steroids, the harm outweighs benefit). Modern management uses DF or MELD to start and Lille to continue, a start-and-reassess pair.
Worked Example
PT 22 seconds, control 12, bilirubin 14 mg/dL: DF = 4.6 x 10 + 14 = 60. Severe, well above 32. This patient enters the steroid-consideration pathway: screen for infection (steroids with untreated infection kill), GI bleeding, and kidney injury first, then prednisolone 40 mg daily if clear, with a Lille score at day 7. Contrast PT 14, control 12, bilirubin 6: DF = 4.6 x 2 + 6 = 15.2, not severe; supportive care and abstinence, no steroids. The PT prolongation dominates the number, which is why coagulopathy is the formula's weighted core.
Treatment Beyond the Number
Corticosteroids (prednisolone 40 mg daily for 28 days) improve 28-day survival in severe alcoholic hepatitis without contraindications, per the STOPAH trial's nuanced findings; non-responders by Lille stop at day 7. Pentoxifylline has fallen out of favor. Nutrition support matters enormously: these patients are profoundly malnourished, and adequate calories and protein improve outcomes. Infection surveillance is constant because steroids mask fever and these patients infect easily.
And the factor that dwarfs all pharmacology: abstinence. Return to drinking erases every medical gain; sustained abstinence is the strongest predictor of long-term survival, stronger than any drug. Transplant for alcoholic hepatitis remains selective and center-dependent, usually requiring demonstrated abstinence. The DF opens the treatment conversation; abstinence decides the ending. Steroid decisions also weigh age, comorbidity, and patient preference alongside the number, and every severe case deserves hepatology involvement early.
Related Calculators
Keep exploring: try our Child-Pugh score and CIWA scale for the next piece of the picture.
For informational purposes only, not medical advice. Consult a healthcare professional.
Frequently Asked Questions
What is Maddrey's discriminant function?
DF = 4.6 x (patient PT - control PT) + serum bilirubin (mg/dL). A score of 32 or above indicates severe alcoholic hepatitis with high short-term mortality, identifying candidates for corticosteroid therapy. Derived by Maddrey et al. in 1978.
What DF score indicates severe alcoholic hepatitis?
32 or above. Below 32, supportive care and abstinence without steroids is the usual path. The threshold marks where mortality justifies corticosteroid risks.
How is severe alcoholic hepatitis treated?
Prednisolone 40 mg daily for 28 days if no contraindications (infection, GI bleed, kidney injury), with Lille score at day 7 to identify non-responders who should stop. Plus nutrition support, infection surveillance, and above all alcohol abstinence.
What is the Lille score?
A day-7 score during steroid treatment for alcoholic hepatitis using bilirubin change, albumin, creatinine, PT, and age. Above 0.45 indicates non-response: steroids should stop because harm outweighs benefit.
What is the mortality of severe alcoholic hepatitis?
30-50% at 30 days without treatment in severe (DF >= 32) disease. Corticosteroids improve 28-day survival in responders; sustained alcohol abstinence is the strongest long-term survival predictor.
Can you use INR instead of PT for Maddrey DF?
The original formula uses PT prolongation in seconds versus control. Some clinicians approximate with INR, but the validated formula uses seconds; use the same-lab control PT as intended.
What is the Glasgow alcoholic hepatitis score?
An alternative severity score using age, white cell count, urea, PT ratio, and bilirubin. Like MELD, it predicts mortality in alcoholic hepatitis; some centers prefer it over Maddrey DF.
Does pentoxifylline treat alcoholic hepatitis?
It was studied as an alternative to steroids but the STOPAH trial found no significant survival benefit, and it has largely fallen out of guidelines. Steroids (in responders) and abstinence remain the evidence-based pillars.
Can alcoholics get liver transplants?
Selectively: many centers require demonstrated abstinence (traditionally 6 months, though early transplant for severe alcoholic hepatitis is practiced at some centers with strict psychosocial criteria). Policies vary by center and region.
What labs diagnose alcoholic hepatitis?
Clinical pattern (heavy alcohol use, rapid jaundice, tender liver) plus labs: markedly high bilirubin, AST/ALT usually <400 with AST:ALT >2, prolonged PT, leukocytosis. Liver biopsy confirms when the diagnosis is uncertain.