Maddrey's Discriminant Function: Severity score for Alcoholic Hepatitis. DF ≥ 32 defines severe disease and guides corticosteroid therapy decision. Sensitivity ~79%.
Guidelines & Evidence
Clinical Details
Section 1
When to Use
When to Use
Active alcoholic hepatitis with jaundice to assess severity
Determine eligibility for corticosteroid therapy
Identify patients requiring ICU-level monitoring
Prognosticate 30-day mortality in active drinkers presenting with liver failure
Required Clinical Context
Must have confirmed or highly suspected alcoholic hepatitis (jaundice + recent heavy alcohol use + AST:ALT > 2:1 + excluding other causes). DF is not meaningful in non-alcoholic liver disease.
Both Maddrey DF and MELD score predict 30-day mortality in AH. MELD > 20 correlates with DF ≥ 32. Some centres use Glasgow AH Score (GAHS) or ABIC score as additional severity tools.
Section 4
Next Steps
Severe AH Management (DF ≥ 32)
01
Prednisolone 40mg orally daily × 28 days (preferred over methylprednisolone)
02
Nutritional support: EN via NGT if oral intake inadequate (target 35–40 kcal/kg/day, 1.2–1.5g protein/kg/day)
03
Thiamine 300mg IV daily × 3 days, then oral B-vitamins
Maddrey WC et al. • Gastroenterology.. 1978;75(2):193–199. DF ≥ 93 originally predicted benefit; revised to ≥ 32 in subsequent validation studies.
Section 6
Literature
Dr. Willis C. Maddrey
A hepatologist who published the discriminant function in 1978 as part of the first RCT of corticosteroids in alcoholic hepatitis. His formula — combining PT prolongation with bilirubin — elegantly captured both synthetic dysfunction and cholestasis in a single score, remaining the entry criterion for steroid trials in AH for over 45 years.
Last Comprehensive Review: 2026
Guidelines & Evidence
Clinical Details
Section 1
When to Use
When to Use
Active alcoholic hepatitis with jaundice to assess severity
Determine eligibility for corticosteroid therapy
Identify patients requiring ICU-level monitoring
Prognosticate 30-day mortality in active drinkers presenting with liver failure
Required Clinical Context
Must have confirmed or highly suspected alcoholic hepatitis (jaundice + recent heavy alcohol use + AST:ALT > 2:1 + excluding other causes). DF is not meaningful in non-alcoholic liver disease.
Both Maddrey DF and MELD score predict 30-day mortality in AH. MELD > 20 correlates with DF ≥ 32. Some centres use Glasgow AH Score (GAHS) or ABIC score as additional severity tools.
Section 4
Next Steps
Severe AH Management (DF ≥ 32)
01
Prednisolone 40mg orally daily × 28 days (preferred over methylprednisolone)
02
Nutritional support: EN via NGT if oral intake inadequate (target 35–40 kcal/kg/day, 1.2–1.5g protein/kg/day)
03
Thiamine 300mg IV daily × 3 days, then oral B-vitamins
Maddrey WC et al. • Gastroenterology.. 1978;75(2):193–199. DF ≥ 93 originally predicted benefit; revised to ≥ 32 in subsequent validation studies.
Section 6
Literature
Dr. Willis C. Maddrey
A hepatologist who published the discriminant function in 1978 as part of the first RCT of corticosteroids in alcoholic hepatitis. His formula — combining PT prolongation with bilirubin — elegantly captured both synthetic dysfunction and cholestasis in a single score, remaining the entry criterion for steroid trials in AH for over 45 years.
