Maddrey Discriminant Function

Predicts severity and prognosis in alcoholic hepatitis.

Gastroenterology GastroenterologyEvidence-BasedUpdated 2026-07

Clinical Notes

Formula

4.6 × (Patient PT − Control PT) + Total Bilirubin

Clinical Notes

Patients with MDF ≥32 are considered to have severe alcoholic hepatitis and may benefit from corticosteroid therapy if no contraindications exist.

References

Maddrey WC et al.
AASLD Practice Guidance.
EASL Clinical Practice Guidelines.

Calculator Information

Specialty

Gastroenterology

📋 Reference Ranges

Reference ranges for this calculator
Classification	Range
Mild Disease	<32
Severe Alcoholic Hepatitis	≥32

What This Calculator Measures

Calculates the Maddrey Discriminant Function to identify severe alcoholic hepatitis, in which corticosteroid therapy may be considered.

How to Use

Enter the patient's prothrombin time, the control (reference) prothrombin time, and total bilirubin.
The score uses the difference between patient and control prothrombin times.
A value ≥32 defines severe alcoholic hepatitis and triggers consideration of corticosteroids if no contraindications exist.

Interpretation Guide

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.

Clinical Significance

The MDF ≥32 threshold is the classic criterion for severe alcoholic hepatitis and remains central to deciding which patients may benefit from corticosteroid therapy.

When to Use

Suspected alcoholic hepatitis
Identifying candidates for corticosteroid therapy
Initial severity assessment in acute-on-chronic alcohol-related liver disease

When Not to Use

Without a secure diagnosis of alcoholic hepatitis
When corticosteroids are contraindicated
Other causes of acute liver injury or cholestatic disease
Children

Limitations

Requires a control prothrombin time and is sensitive to laboratory variation.
Diagnosis of alcoholic hepatitis itself rests on clinical and often biopsy-based criteria.
The score does not capture treatment response, which is assessed separately (e.g., with the Lille score).

Worked Example

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:

patient_pt: 20

control_pt: 13

bilirubin: 8

MDF = 4.6 × (20 − 13) + 8 = 40.2 — severe alcoholic hepatitis (MDF ≥32); corticosteroid therapy should be considered if no contraindications exist.

Evidence

Source: Hepatology / Gastroenterology
Reference: Madrey WC, et al. Hepatology. 1998;28(6):1561-1563.
Reviewed By: MedCalcHub Clinical Team
Version: 1998
Updated: 2026-08

Madrey WC, et al. Hepatology. 1998;28(6):1561-1563.

References

Maddrey WC, et al. Corticosteroid therapy of alcoholic hepatitis. Gastroenterology. 1978;75:193-199. (Original score)

Disclaimer: This calculator is intended for educational and clinical decision support. The diagnosis of alcoholic hepatitis and treatment decisions must be individualized with clinical judgment.