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Predicts severity and prognosis in alcoholic hepatitis.
Clinical decision-support tool for qualified healthcare professionals. Results are not a diagnosis and should not replace professional clinical judgment.
Patients with MDF ≥32 are considered to have severe alcoholic hepatitis and may benefit from corticosteroid therapy if no contraindications exist.
Specialty
GastroenterologyCategory
GastroenterologyDifficulty
Basic
Estimated Time
30 seconds
Version
1.0
Last Updated
2026-07
Formula
Keywords
| Classification | Range |
|---|---|
Mild Disease | <32 |
Severe Alcoholic Hepatitis | ≥32 |
Calculates the Maddrey Discriminant Function to identify severe alcoholic hepatitis, in which corticosteroid therapy may be considered.
Maddrey discriminant function = 4.6 x (patient prothrombin time - control prothrombin time) + total bilirubin, with prothrombin times in seconds and bilirubin in mg/dL. Values of 32 or greater indicate severe alcoholic hepatitis.
Patient prothrombin time in seconds, from which the control PT is subtracted.
Laboratory control prothrombin time in seconds, subtracted from the patient PT.
Total serum bilirubin in mg/dL, added to the prolonged prothrombin time term.
MDF <32 indicates mild alcoholic hepatitis with a less ominous short-term prognosis; MDF ≥32 indicates severe alcoholic hepatitis, where corticosteroid therapy should be considered in the absence of contraindications.
The MDF ≥32 threshold is the classic criterion for severe alcoholic hepatitis and remains central to deciding which patients may benefit from corticosteroid therapy.
A 45-year-old man with heavy alcohol use and clinical alcoholic hepatitis has a prothrombin time of 20 seconds (control 13 seconds) and total bilirubin 8 mg/dL.
Inputs:
Expected Result: MDF = 4.6 × (20 − 13) + 8 = 40.2 — severe alcoholic hepatitis (MDF ≥32); corticosteroid therapy should be considered if no contraindications exist.
The Maddrey discriminant function is built on the difference between the patient's prothrombin time and a control value, both in seconds, multiplied by 4.6 and then added to total bilirubin in mg/dL. Prothrombin time reagents and instrumentation vary between laboratories, so using the matched control keeps the difference meaningful rather than depending on an absolute number.
An MDF of 32 or greater defines severe alcoholic hepatitis and is the classic threshold for considering corticosteroid therapy, but only when there are no contraindications. The underlying diagnosis of alcoholic hepatitis itself rests on clinical and often biopsy-based criteria, and the score does not capture contraindications, so the treatment decision remains clinical.
No. The MDF is intended for suspected alcoholic hepatitis and should not be applied to other causes of acute liver injury or cholestatic disease, or used without a secure diagnosis of alcoholic hepatitis. It is also not validated in children, and the score does not replace the broader clinical and sometimes biopsy-based assessment required to establish the diagnosis.
Disclaimer: This calculator is intended for educational and clinical decision support purposes only. The diagnosis of alcoholic hepatitis and treatment decisions must be individualized with clinical judgment.