Calculate the Maddrey Discriminant Function (MDF) for alcoholic hepatitis severity. Determine steroid eligibility with MELD comparison and treatment algorithm.
The Maddrey Discriminant Function (MDF) Calculator determines the severity of acute alcoholic hepatitis and guides corticosteroid treatment decisions. Developed by Maddrey et al. in 1978, the MDF remains the most widely used tool for identifying patients with severe alcoholic hepatitis who may benefit from corticosteroid therapy.
Alcoholic hepatitis is an acute inflammatory liver condition caused by heavy alcohol use, with severe forms carrying 28-day mortality rates of 30–50% without treatment. The Maddrey Discriminant Function uses only two laboratory values — prothrombin time and total bilirubin — to calculate a score that stratifies patients into severe (MDF ≥ 32) and non-severe (MDF < 32) categories.
Patients with severe alcoholic hepatitis (MDF ≥ 32) benefit from prednisolone 40 mg daily for 28 days, which has been shown to reduce short-term mortality by approximately 30%. However, steroid response must be reassessed at day 7 using the Lille score — non-responders (Lille ≥ 0.45) should have steroids discontinued. This calculator provides the MDF, MELD score for comparison, treatment algorithm, and Lille score guidance for comprehensive alcoholic hepatitis management.
Severe alcoholic hepatitis has high mortality without treatment, but corticosteroids are only beneficial for patients meeting the MDF ≥ 32 threshold. Accurate calculation prevents both under-treatment (withholding steroids from patients who would benefit) and over-treatment (exposing lower-risk patients to steroid side effects including infection risk). Keep these notes focused on your operational context.
Maddrey Discriminant Function (MDF): MDF = 4.6 × (Patient PT − Control PT) + Total Bilirubin (mg/dL) Threshold: MDF ≥ 32 = Severe alcoholic hepatitis MELD = 3.78 × ln(Bilirubin) + 11.2 × ln(INR) + 9.57 × ln(Creatinine) + 6.43 Lille Score (day 7): Uses day-0 and day-7 bilirubin, age, albumin, creatinine, PT • Lille < 0.45: Steroid responder → complete 28-day course • Lille ≥ 0.45: Non-responder → stop steroids
Result: MDF = 4.6 × (22−12) + 12 = 58.0 — Severe Alcoholic Hepatitis
MDF 58.0 exceeds the ≥32 threshold, indicating severe alcoholic hepatitis. Prednisolone 40 mg/day is recommended. Estimated 28-day mortality without treatment is 35–50%. The Lille score should be calculated at day 7 to determine if steroids should be continued (Lille <0.45 = responder) or stopped (Lille ≥0.45 = non-responder).
Alcoholic hepatitis develops from chronic heavy drinking (typically >40 g/day in women, >60 g/day men for >5 years) through a cascade of liver injury: alcohol metabolism produces acetaldehyde and reactive oxygen species → hepatocyte injury → neutrophilic inflammation → Mallory-Denk bodies → fibrosis. Severe cases manifest with jaundice, coagulopathy, ascites, and hepatic encephalopathy. The hallmark of alcoholic hepatitis is elevated AST (typically 2–6× normal with AST>ALT ratio >2).
The STOPAH trial (Stewart et al., NEJM 2015) remains the definitive study: prednisolone showed a trend toward reduced 28-day mortality (OR 0.72, p=0.06) that reached significance in subsequent meta-analyses. Pentoxifylline showed no benefit. The trial confirmed the importance of the Lille score for identifying non-responders at day 7. Current guidelines recommend prednisolone as first-line for MDF ≥32.
New approaches under investigation include: N-acetylcysteine (NAC) as adjunct to steroids (showed improved 1-month survival in one trial), granulocyte colony-stimulating factor (G-CSF) for stimulating liver regeneration, IL-22 for hepatoprotection, and FXR agonists like obeticholic acid. The microbiome is also being explored as a therapeutic target through fecal microbiota transplantation (FMT) in early studies.
The MDF is a clinical scoring system developed in 1978 to identify patients with severe alcoholic hepatitis who may benefit from corticosteroid therapy. It calculates severity using prothrombin time prolongation (weighted by 4.6) and total bilirubin. A score ≥ 32 indicates severe disease with significant mortality risk, warranting corticosteroid treatment.
MDF ≥ 32 defines severe alcoholic hepatitis with 28-day mortality of 30–50% without treatment. These patients should receive prednisolone 40 mg/day for 28 days (if no contraindications), which reduces short-term mortality by approximately 30%. Non-severe cases (MDF <32) have <10% 28-day mortality and do not benefit from steroids.
The Lille score is calculated at day 7 of steroid therapy to identify non-responders early. It uses the change in bilirubin from day 0 to day 7, along with age, albumin, creatinine, and PT. A Lille score ≥ 0.45 indicates non-response, and steroids should be stopped (as continuing provides no benefit and increases infection risk). A Lille < 0.45 predicts benefit from completing the 28-day course.
Major contraindications include: active infection (especially SBP — perform diagnostic paracentesis before steroids), uncontrolled GI bleeding, acute pancreatitis, severe renal failure (hepatorenal syndrome — consider terlipressin or albumin), and hepatitis B virus reactivation risk. Some centers also avoid steroids in patients with very high MDF (>54) due to extreme mortality despite treatment.
No. The STOPAH trial (2015), the largest randomized trial in alcoholic hepatitis (1,103 patients), showed that pentoxifylline did not improve survival either alone or in combination with prednisolone. Current AASLD/EASL guidelines no longer recommend pentoxifylline for alcoholic hepatitis. Prednisolone remains the only proven pharmacotherapy.
Historically, most transplant centers required 6 months of sobriety. However, the growing body of evidence (especially from the ACCELERATE trial and French and Belgian studies) supports early liver transplantation in selected patients with severe alcoholic hepatitis who fail medical therapy, with excellent outcomes. Careful selection protocols (social support, psychiatric evaluation, commitment to sobriety) are essential.