Maddrey’s Discriminant Function (MDF)
Maddrey Discriminant Function:
Interpretation:
Note: This calculator is for educational use only and does not replace clinical judgment. Refer to full clinical context, guidelines, and expert consultation when managing alcoholic hepatitis.
Maddrey Discriminant Function (MDF) in Alcoholic Hepatitis
The Maddrey Discriminant Function (MDF) is a clinical tool designed to assess the severity of alcoholic hepatitis and predict short-term outcomes. By measuring both coagulopathy (through comparing a patient’s prothrombin time to a control value) and bilirubin levels, the MDF provides a score that helps guide treatment decisions and clinical management.
How the MDF Is Calculated
The formula for the Maddrey Discriminant Function
- Patient’s PT (in seconds) is compared to a control/reference PT value, reflecting the liver’s synthetic function and degree of coagulopathy.
- Total bilirubin (in mg/dL) is added, indicating the liver’s ability to process bilirubin.
Interpretation
- MDF ≥ 32: Suggests severe alcoholic hepatitis, typically associated with higher short-term mortality. Patients in this range often benefit from glucocorticoid therapy (e.g., steroids), assuming no contraindications.
- MDF < 32: Indicates a lower severity of disease, though careful monitoring and supportive care remain crucial.
Clinical Utility
- Decision-Making for Steroids: A key use of the MDF score is determining whether a patient with alcoholic hepatitis may benefit from glucocorticoid therapy to reduce inflammation and improve outcomes.
- Risk Stratification: By quantifying the severity of alcoholic hepatitis, clinicians can identify patients at higher risk who may need more intensive monitoring or supportive interventions.
- Prognostic Value: Although MDF primarily guides short-term decision-making, it can also offer insight into the immediate risk of complications, aiding in family discussions and overall treatment planning.
The Role of the Calculator
A Maddrey Discriminant Function calculator simplifies this process by automatically computing the MDF score once the clinician inputs:
- Patient’s PT (seconds)
- Control PT (seconds)
- Total Bilirubin (mg/dL)
The calculator then displays the resulting score and categorizes it based on the 32-point threshold. This automated approach:
- Saves time and minimizes manual calculation errors.
- Allows consistent application of the MDF across various clinical settings.
- Fosters evidence-based practice, ensuring that patients with severe alcoholic hepatitis are rapidly identified for possible steroid therapy.
Reference
Maddrey WC, Boitnott JK, Bedine MS, Weber FL Jr, Mezey E, White RI Jr. Corticosteroid therapy of alcoholic hepatitis. Gastroenterology. 1978 Aug;75(2):193-9. PMID: 352788.
