Maddrey’s DF

Assesses severity and mortality risk in alcoholic hepatitis

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Maddrey's Discriminant Function for Alcoholic Hepatitis

Maddrey’s DF

Assesses severity and mortality risk in alcoholic hepatitis

Maddrey's Discriminant Function for Alcoholic Hepatitis

Suggests which patients with alcoholic hepatitis may have a poor prognosis and benefit from steroid administration.

Prothrombin Time (PT)

seconds

Control PT (normal value)

Typical normal PT value (often 12 seconds)

seconds

Total Bilirubin

DF — Enter all values

1/3 entered · DF = 4.6 × (PT - control PT) + bilirubin

Instructions

Maddrey’s Discriminant Function (DF) is a clinical tool used to assess prognosis in patients with alcoholic hepatitis. To apply it, clinicians need laboratory values of prothrombin time (PT) and serum bilirubin. The calculation determines the severity of liver dysfunction and stratifies patients into mild or severe disease categories. A higher DF score signals worse prognosis and may indicate the need for corticosteroid therapy or other intensive management. This tool helps guide therapeutic decisions and provides valuable prognostic information.

Overview

When to use

Why use

Evidences

Interpretation

Discriminant Function is calculated as:
4.6 × (Patient’s Prothrombin Time – Control Prothrombin Time) + Total Bilirubin

Maddrey’s DF Score	Interpretation
< 32	Mild to moderate alcoholic hepatitis
≥ 32	Severe alcoholic hepatitis

MDF was the first widely adopted prognostic score for alcoholic hepatitis and remains common in trials and practice to identify high short‑term mortality risk candidates for therapy.
https://pmc.ncbi.nlm.nih.gov/articles/PMC10494564/

Contemporary evidence suggests MELD may provide better mortality prediction than MDF, especially beyond 30 days; many centers use MELD alongside MDF and then apply the Lille score at day 4–7 to assess steroid response and decide continuation.
https://pmc.ncbi.nlm.nih.gov/articles/PMC7230003/

Retrospective analysis of 882 patients showed that using different PTcontrol values (e.g., 12, 13.5, 14.8 s) materially changes how many patients meet MDF ≥32 and receive steroids, though 30‑day survival differences were not demonstrated; MELD was a more stable predictor of 30‑day survival in that cohort.
https://pmc.ncbi.nlm.nih.gov/articles/PMC9775026/

Use MDF within a multimodal framework that includes MELD and clinical judgment, and consider early transplant evaluation in nonresponders or fulminant cases meeting center criteria
https://pmc.ncbi.nlm.nih.gov/articles/PMC11007324/

Overview

When to use

Why use

Evidences

Maddrey’s Discriminant Function, also known as Maddrey’s DF or MDF, is one of the oldest and most widely used scoring systems to evaluate the severity of alcoholic hepatitis and predict short-term mortality risk. Alcoholic hepatitis is an inflammatory liver condition triggered by heavy alcohol consumption, characterized by jaundice, coagulopathy, and liver dysfunction. Since outcomes vary widely, clinical scoring tools like MDF are essential for identifying patients at highest risk who may benefit from corticosteroids or other therapies.

The MDF score is derived from two key lab values: prothrombin time and serum bilirubin. Both parameters reflect the degree of impaired liver function. A higher score correlates with more severe disease and higher short-term mortality. Traditionally, a DF score of ≥32 is considered a critical threshold, identifying patients with severe alcoholic hepatitis who have poor prognosis without treatment. Patients with lower scores are typically managed with supportive care, while those with higher scores may be considered for corticosteroid therapy or clinical trials of advanced therapies.

This tool is most valuable because it helps clinicians make evidence-based decisions in a condition where treatment options are limited and outcomes can be poor. It is widely used in hepatology and intensive care settings