Maddrey's Discriminant Function for Alcoholic Hepatitis
Predicts 30-day mortality in alcoholic hepatitis and identifies patients who benefit from corticosteroid therapy (prednisolone). DF ≥ 32 indicates severe disease.
Score interpretation
Maddrey's DF < 32: Mild to moderate alcoholic hepatitis. 30-day mortality < 15%.
→ Supportive management. Abstinence from alcohol (thiamine/Pabrinex). Nutritional support (enteral feeding). Pentoxifylline not routinely recommended. Monitor LFTs, INR, bilirubin.
Maddrey's DF ≥ 32: Severe alcoholic hepatitis. 30-day mortality ~30–50%.
→ Prednisolone 40mg OD × 28 days (if no contraindications: active infection, GI bleed, renal failure, HBV). Calculate Lille score at Day 7 to assess steroid response. If Lille > 0.45 at Day 7 → stop steroids (non-response). N-acetylcysteine as adjunct. Liver unit referral.
Interpretation bands for the Maddrey's DF. Apply clinical judgement and local guidance.
References
- Maddrey WC, et al. Corticosteroid therapy of alcoholic hepatitis. Gastroenterology. 1978;75(2):193–199.
- NICE CG100. Alcohol-use disorders: diagnosis and clinical management of alcohol-related physical complications. 2010.
Related
Curated clinical cross-links plus same-class fallbacks.
- Upper GI Bleeding · BSG Guidelines 2019; NICE NG141
- Lower Gastrointestinal Bleed · NICE; BSG; ACPGBI — Commissioning Guide
- Acute Pancreatitis · NICE; IAP/APA; ACPGBI — CG104
- Sepsis Screening and Sepsis Six · UK Sepsis Trust; NICE NG51; Surviving Sepsis Campaign 2021
- Unintentional Weight Loss Workup · NICE NG12; BSG
- Chronic Fatigue Workup · NICE NG206; BMJ Best Practice
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.