Calculators · Gastroenterology & Hepatology · Formula

Maddrey discriminant function

Also called mDF, Maddrey DF, modified discriminant function

Severity of alcohol-associated hepatitis; DF ≥ 32 identifies severe disease where corticosteroids were trialled.

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Formula and scoring

DF = 4.6 × (patient PT − control PT, seconds) + bilirubin (mg/dL). With bilirubin in µmol/L, divide by 17.1.

Exam and ward pearls

  • The 4.6 multiplier and the threshold of 32 are as used in the Carithers 1989 trial; spontaneous encephalopathy also qualified as severe.
  • Day-7 response to steroids is judged with the Lille model (score > 0.45 = non-responder).

When not to rely on it

  • Depends on the PT reagent and control value; it uses seconds, not INR.

Source

  1. Carithers RL Jr, Herlong HF, Diehl AM, et al. Methylprednisolone therapy in patients with severe alcoholic hepatitis. A randomized multicenter trial. Ann Intern Med. 1989;110(9):685-90. doi:10.7326/0003-4819-110-9-685 · PMID 2648927
  2. Maddrey WC, Boitnott JK, Bedine MS, et al. Corticosteroid therapy of alcoholic hepatitis. Gastroenterology. 1978;75(2):193-9. PMID 352788
  3. Louvet A, Naveau S, Abdelnour M, et al. The Lille model: a new tool for therapeutic strategy in patients with severe alcoholic hepatitis treated with steroids. Hepatology. 2007;45(6):1348-54. doi:10.1002/hep.21607 · PMID 17518367

Formula and cut-offs checked against these sources on 8 Nov 2026. Educational tool for clinicians; it does not replace clinical judgement.

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