Maddrey's Discriminant Function Calculator

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Choose the unit reported by your laboratory. The calculator converts to mg/dL internally.
The patient's measured prothrombin time in seconds. A normal PT is roughly 11-13.5 seconds in the absence of anticoagulants.
seconds
The laboratory control (reference) prothrombin time in seconds, typically 11-13.5 seconds. This is reported alongside the patient value on the coagulation panel.
seconds
Serum total bilirubin. Normal is approximately 0.3-1.2 mg/dL (5-21 umol/L). Markedly elevated values are common in alcoholic hepatitis.
mg/dL
Maddrey Discriminant FunctionSevere alcoholic hepatitis
33.6

mDF = 4.6 x (PT patient - PT control) + bilirubin (mg/dL)

PT prolongation6seconds
Bilirubin (mg/dL)6mg/dL
Estimated 30-day mortality35-45% within 30 days (severe)
Corticosteroid considerationScore >= 32: evaluate for corticosteroid therapy (prednisolone) if no contraindications
33.6 mDF
Mild-to-moderate<32Severe32-55Very severe55+

mDF 33.6: severe disease, 35-45% 30-day mortality risk.

  • An mDF of 32 or above identifies severe alcoholic hepatitis, associated with 30-day mortality of 35-45% in the original Maddrey cohort.
  • These patients are candidates for a formal corticosteroid evaluation. Prednisolone 40 mg/day for 28 days is the most studied regimen, provided there are no active infections, gastrointestinal bleeding, or renal failure contraindicating steroids.
  • Response to steroids can be monitored with the Lille score at day 7: a Lille score above 0.45 predicts poor response and is a signal to stop treatment.
  • The PT prolongation of 6.0 s contributes 27.6 points to the score, reflecting impaired hepatic synthesis of clotting factors.
  • The bilirubin of 6.00 mg/dL contributes 6.0 points and reflects the degree of cholestasis and hepatocellular dysfunction.

Next stepRefer urgently to hepatology. Rule out active infection before starting steroids. Consider a Lille score at day 7 to assess steroid response.

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