Maddrey's Discriminant Function Calculator
Calculate Maddrey's Discriminant Function score to assess 30-day mortality risk in alcoholic hepatitis patients.
Enter the patient's prothrombin time, control PT, and total bilirubin to compute the Maddrey score and mortality risk category.
Maddrey's Discriminant Function Calculator
Calculate Maddrey's Discriminant Function score to assess 30-day mortality risk in alcoholic hepatitis patients.
About Maddrey's Discriminant Function Calculator
Maddrey's Discriminant Function (MDF), also known as the Maddrey score, is a validated clinical scoring tool used to assess the severity and predict the short-term prognosis of alcoholic hepatitis. It was originally described by Dr. Willis C. Maddrey and colleagues in 1978 and has since become one of the most widely used prognostic models in hepatology.
The formula is: MDF = 4.6 × (Patient PT − Control PT) + Total Bilirubin (mg/dL). A score of 32 or above identifies patients with severe alcoholic hepatitis who are at significant risk of 30-day mortality. These patients have historically benefited from corticosteroid therapy, specifically prednisolone 40 mg/day for 28 days. Multiple randomized controlled trials have demonstrated that corticosteroids improve short-term survival in patients with MDF ≥ 32 who have no contraindications such as active infection, gastrointestinal bleeding, or renal failure.
For patients who do not respond to corticosteroids within 7 days, the Lille score can be calculated to determine whether continuing treatment is beneficial. The Lille score integrates changes in bilirubin over the first week and identifies early non-responders for whom continuing steroids provides no survival benefit.
Pentoxifylline (400 mg three times daily for 4 weeks) is an alternative for patients in whom corticosteroids are contraindicated. It acts by inhibiting tumor necrosis factor-alpha (TNF-α) synthesis and reducing the inflammatory cascade in alcoholic hepatitis. However, more recent evidence (STOPAH trial) suggests pentoxifylline may not significantly improve survival compared to placebo.
Complete and sustained abstinence from alcohol is the single most important intervention in alcoholic hepatitis and alcoholic liver disease. Liver transplantation may be considered for carefully selected patients with severe alcoholic hepatitis who do not respond to medical therapy, though criteria vary between centers.
This calculator is intended for use by healthcare professionals as a clinical decision support tool and should be interpreted in the context of the full clinical picture, including laboratory values, imaging, clinical assessment, and contraindications to therapy.
Maddrey Score Examples
Clinical scenarios illustrating how the MDF score guides management decisions.
| PT / Control PT / Bilirubin | MDF Score | Risk Category |
|---|---|---|
| PT 14.0s, Control 12.0s, Bilirubin 2.5 mg/dL | 11.7 | Low Risk (< 32). Supportive care and abstinence recommended. No steroids indicated. |
| PT 16.5s, Control 12.0s, Bilirubin 8.0 mg/dL | 28.7 | Approaching threshold. Close monitoring required; reassess if clinical deterioration. |
| PT 20.0s, Control 12.0s, Bilirubin 15.0 mg/dL | 51.8 | Severe Disease (≥ 32). Consider prednisolone if no contraindications. |
| PT 25.0s, Control 12.0s, Bilirubin 25.0 mg/dL | 84.8 | Very High Risk (> 54). Poor prognosis. Specialist hepatology input essential. |
How to Use the Maddrey Score Calculator
- Obtain the patient's prothrombin time (PT) in seconds from a fresh coagulation panel.
- Record the laboratory's control PT value (typically 11–13 seconds) from the same report.
- Enter the total bilirubin in mg/dL from the same blood draw for consistency.
- Click Calculate Score. The MDF score and risk category are displayed instantly.
- Use the result to guide management: MDF ≥ 32 indicates severe alcoholic hepatitis and supports consideration of corticosteroid therapy after excluding contraindications.
Maddrey Discriminant Function FAQ
What MDF score indicates severe alcoholic hepatitis?
An MDF score of 32 or above is the traditional threshold for severe alcoholic hepatitis. Patients with scores at or above this level have a 30-day mortality rate of approximately 30–50% without treatment and are the population most likely to benefit from corticosteroid therapy. Scores above 54 are associated with an even higher mortality risk.
Is the Maddrey score still relevant with newer scoring systems available?
Yes. Despite the development of newer models such as the MELD score, ABIC score, and Glasgow Alcoholic Hepatitis Score, the Maddrey DF remains widely used and is specifically referenced in clinical guidelines for the management of alcoholic hepatitis. It has the advantage of simplicity — requiring only two values — and has strong historical validation.
Can I use bilirubin in µmol/L instead of mg/dL?
This calculator uses bilirubin in mg/dL, as specified in the original Maddrey formula. To convert from µmol/L to mg/dL, divide the µmol/L value by 17.1. For example, a bilirubin of 171 µmol/L equals 10 mg/dL. Using unconverted µmol/L values will produce an incorrect and significantly elevated score.
What are the contraindications to corticosteroids in alcoholic hepatitis?
Absolute contraindications to corticosteroids in alcoholic hepatitis include active uncontrolled infection (including spontaneous bacterial peritonitis), active gastrointestinal bleeding, and severe renal failure. Relative contraindications include uncontrolled diabetes, severe psychiatric illness, and active tuberculosis. A full clinical assessment is essential before initiating steroid therapy.
What is the Lille score and when is it used?
The Lille score is calculated at day 7 of corticosteroid therapy and predicts whether a patient with severe alcoholic hepatitis is responding to treatment. It incorporates age, renal function, albumin, PT, and bilirubin at baseline and day 7. A Lille score above 0.45 identifies non-responders, for whom continuing steroids provides no survival benefit.
Is this calculator intended for clinical use?
This calculator is intended as a clinical decision support and educational tool for healthcare professionals. It should not replace clinical judgment, a thorough patient assessment, or consultation with specialist hepatology services. All clinical decisions should be made by qualified medical professionals with access to the full clinical picture and current evidence-based guidelines.