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Maddrey discriminant function for alcoholic hepatitis

Calculate Maddrey's discriminant function from the prothrombin time and bilirubin to identify severe alcoholic hepatitis.

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Maddrey discriminant function

44.8

32 or more: severe alcoholic hepatitis; corticosteroids may be considered
Prothrombin time prolongation
8.0 s
Bilirubin used
8.0 mg/dL

A 1978 score still in daily use

Alcoholic hepatitis is an acute inflammation of the liver in people who drink heavily, often over years. It causes jaundice, fever and an enlarged, tender liver, and its severe forms carry a high short-term risk of death. In 1978, Willis Maddrey and colleagues showed that two routine blood tests could identify the patients most at risk. A 1989 follow-up study set the threshold of 32 that is still used today:

DF = 4.6 × (patient’s prothrombin time − control time) + total bilirubin (mg/dL)

  • Prothrombin time measures how long blood takes to clot. A sick liver makes fewer clotting factors, so the time lengthens.
  • Bilirubin is the yellow pigment the liver normally clears. It builds up when the liver fails, causing jaundice.

How to read the result

  • Below 32: non-severe disease. Most patients recover with abstinence, nutrition and supportive care.
  • 32 or more: severe alcoholic hepatitis. Without treatment, roughly 30 to 50% of patients died within a month in the early studies. Corticosteroids such as prednisolone may be considered if there is no infection or bleeding.

Worked example

A patient has a prothrombin time of 20 seconds against a laboratory control of 12 seconds, and a bilirubin of 8 mg/dL.

DF = 4.6 × (20 − 12) + 8 = 36.8 + 8 = 44.8

The score is above 32, so the disease is classified as severe.

Practical notes

  • Use the prothrombin time in seconds and the laboratory’s own control value, not the INR.
  • If your laboratory reports bilirubin in µmol/L, divide by 17.1 to get mg/dL.
  • The score was designed for alcoholic hepatitis only. It does not apply to other liver diseases.
  • Doctors often add the MELD score and, after a week of steroids, the Lille model to judge whether treatment is working.
  • Stopping alcohol completely is the single most important factor for long-term survival. Support is available from your doctor and from SAMHSA’s National Helpline (1-800-662-4357).

This calculator is for general information and education. It is not medical advice and does not replace the judgment of a doctor, nurse or pharmacist who knows the full clinical picture.

Frequently asked questions

What is the Maddrey discriminant function?

A score for alcoholic hepatitis: 4.6 × (patient's prothrombin time − control) + bilirubin in mg/dL. Willis Maddrey and colleagues introduced it in 1978, and it is still used to decide who might benefit from corticosteroids.

What score is severe?

32 or more indicates severe alcoholic hepatitis, with a high risk of death within one month without treatment. Below 32, the short-term outlook is much better.

Why can't I use the INR?

The original formula uses the prothrombin time in seconds and the laboratory's control value. Using the INR in its place gives a different number. Most lab reports list both the patient's time and the control.

Are other scores used as well?

Yes. The MELD score is also used to judge severity, and the Lille model, calculated after 7 days of corticosteroids, shows whether the treatment is working. Decisions belong to the hepatology team.

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Results are estimates provided for information purposes. They do not replace professional advice.

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