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Maddrey Discriminant Function (Alcoholic Hepatitis)

Maddrey's modified discriminant function = 4.6 × (patient PT − control PT) + bilirubin (mg/dL). A score ≥32 defines severe alcohol-associated hepatitis with high 1-month mortality, where corticosteroids may be considered.

  • Prothrombin time (patient)
  • Control (reference) prothrombin time
  • Total bilirubin (mg/dL or µmol/L)
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Interpretation

ResultMeaning
< 32Non-severe; low short-term mortality
≥ 32Severe; ~30–50% 1-month mortality untreated in historical cohorts; consider corticosteroids

Formula

DF = 4.6 × [patient PT (s) − control PT (s)] + total bilirubin (mg/dL) (bilirubin µmol/L ÷ 17.1)

Clinical pearls

  • Use the laboratory's control PT; 12 s is assumed if not entered, and a different reagent can shift DF by several points.
  • Reassess response at day 7 with the Lille model; MELD >20 also identifies severe disease.

Examples

maddrey pt 20 control 12 bili 8Maddrey discriminant function: prothrombin time 18 seconds, bilirubin 150 umol/Lmdf pt 15 bili 3 control 11

FAQ

What Maddrey score needs steroids?

A discriminant function ≥32 defines severe alcohol-associated hepatitis where prednisolone 40 mg/day is considered, after excluding infection and GI bleeding.

What is the original vs modified Maddrey?

The 1978 original used 4.6 × PT prolongation + bilirubin with a cut-off of 93 (bilirubin in µmol/L); the 1989 modified version in mg/dL uses ≥32.

Evidence

  1. Carithers RL Jr et al. Methylprednisolone therapy in patients with severe alcoholic hepatitis. Ann Intern Med 1989;110:685–90.
  2. Maddrey WC et al. Corticosteroid therapy of alcoholic hepatitis. Gastroenterology 1978;75:193–9.

Hepatology & GI · Reviewed 2026-10-14 · Methodology