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Maddrey's Discriminant Function for Alcoholic Hepatitis

Calculators  Immunology
Maddrey's Discriminant Function for Alcoholic Hepatitis is an practical tool utilized to evaluate the severity and prognosis of alcoholic hepatitis
PT
s
PT control/reference level
s
Total bilirubin
µ
Result:

Background

Measured Factor
Maddrey's Discriminant Function
Measured Factor Disease
  • Alcoholic Hepatitis
Measured Factor Detail
Maddrey's Discriminant Function for Alcoholic Hepatitis is used to predict the prognosis of alcoholic hepatitis. The calculation takes into account patient features such as level of PT (Prothrombin Time), level of PT control/reference and total bilirubin level.
Speciality
Immunologist
Body System
Immunology
Formula
Discriminant Function = 4.6 * (Pt's PT - Control PT) + TBili
Measured Factor Low Impact
  • Score <32 illustrates good prognosis
Measured Factor High Impact
  • Score >32 indicates poor prognosis and patient may benefit from glucocorticoid therapy

Result Interpretation

Ranges Ranges
  • Critical High: >32
  • Normal: <32
  • Normal Adult Male: <32
  • Normal Adult Female: <32
  • Normal Geriatric Male: <32
  • Normal Geriatric Female: <32
Result High Conditions
  • Alcoholic Hepatitis
False Positive
  • Genetic polymorphisms of transferrin
  • Inborn error of glycoprotein metabolism
  • Severe liver disease
References: 2
Test Limitations
Maddrey discriminant function showed limitations due to variable results of prothrombin time from different laboratories.
References: 3

Studies

Study Validation 1
A validation study was conducted from January 2012 to December 2015 with the retrospective analysis in the Gastroenterology department of the hospital for severe alcoholic hepatitis. Results from 88 patients aged 45.6 ± 7.6 years with Maddrey's Discriminant Function (mDF), MELD, ABIC, Glasgow, and MAGIC calculated. 23.9% and 47.7% mortality observed on day 30 and day 90 respectively. 100% survival probability for mDF < 32 and 42.25 ± 4.46% for mDF > 32 with p = 0.0001. Other prognostic scoring system had less predictive value than mDF, followed by AUROC 0.872, Glasgow 0.707, MAGIC 0.626, MELD 0.772, and ABIC 0.663.  In addition, the study indicates the accessibility of the mDF with severe alcoholic hepatitis compared to other systems.
References: 4
Study Validation 2
A validation study was conducted for Maddrey Discriminant Function (mDF) in hospitalized patient for severe alcoholic hepatitis. Results from 554 patients mean age 50 years with Maddrey's Discriminant Function (mDF) and MELD calculated. 25% of patients observed high creatinine and 15% with hepatorenal syndrome. mDF had p = 0.001 and MELD had p < 0.0001, AUROC of mDF was 0.795 (95% CI 0.65; 0.93) and AUROC of MELD was 0.867 (95% CI 0.75; 0.97).  In addition, the study indicates the overall accuracy of the mDF better than MELD with severe alcoholic hepatitis.
References: 5
Study Validation 3
A cross-validation study was conducted for Maddrey Discriminant Function (mDF), Mayo End-stage Liver Disease (MELD), Glasgow Alcoholic Hepatitis Score (GAHS), UK End-stage Liver Disease (UKELD), and Age, Bilirubin, INR, Creatinine (ABIC) in the hospitalized patient for severe alcoholic hepatitis. Results from 31 patients with areas under the receiver operating characteristics curve (AUROC) were mDF 0.71/0.74, MELD 0.79/0.84, GAHS 0.75/0.78, UKELD 0.56/0.68, ABIC 0.71/0.78 relative to day 30/90 respectively calculated. In addition, the study indicates the validity of the mDF with severe alcoholic hepatitis.
References: 6
Study Additional 1
A study was conducted between January 2008 and August 2012 for Maddrey Discriminant Function (mDF) and Model for End-stage Liver Disease (MELD) in the hospitalized patient for severe alcoholic hepatitis in the Canadian population. Results from 122 patients median aged 49 years with areas under the receiver operating characteristics curve (AUROC) were mDF 068, MELD 0.64 relative to day 90 calculated. In addition, the study indicates the good prediction 90-day mortality with the mDF in hospitalized patients for severe alcoholic hepatitis.
References: 7
Study Additional 2
A meta-analysis was conducted to check the efficacy of corticosteroid with Discriminant Function (DF) in the hospitalized patient for severe alcoholic hepatitis. Results were calculated from 113 corticosteroid patients and 102 placeboes with DF > or = 32. Corticosteroid patients had higher survival rate as compared to placebo with 84.6+/-3.4% vs 65.1+/-4.8% (p = 0.001) at 28 day. In addition, corticosteroid improved patients survival rate with severe alcoholic hepatitis.
References: 8
Study Additional 3
A meta-analysis was conducted to check efficacy of corticosteroid with Maddrey Discriminant Function (DF) in patient with severe alcoholic hepatitis. Results were calculated from 221 corticosteroid patients and 197 non-corticosteroid with DF > or = 32. At 28 day, corticosteroid patients had higher survival rate as compared to non-corticosteroid with 79.97±2.8% vs 65.7±3.4% (p = 0.0005). Corticosteroid had good survival effect on day 28 with HR 0.18 (p = 0.006). In addition, analysis showed that corticosteroid improved patients survival rate at 28 day with severe alcoholic hepatitis.
References: 9

References

  1. Soultati AS, Dourakis SP, Alexopoulou A, Deutsch M, Vasilieva L, Archimandritis AJ. Predicting utility of a model for end stage liver disease in alcoholic liver disease. World J Gastroenterol. 2006;12(25):4020-5.
  2. Vonghia L, Michielsen P, Dom G, Francque S. Diagnostic challenges in alcohol use disorder and alcoholic liver disease. World J Gastroenterol. 2014;20(25):8024-32.
  3. Rahimi E, Pan JJ. Prognostic models for alcoholic hepatitis. Biomark Res. 2015;3:20.
  4. Iyer A, Govindaraju C, Sathar S, Sreesh S, Devadas K. Validation Study to Predict Mortality in Alcoholic Hepatitis: Magic Score Versus Other Scoring Systems. Journal of Clinical and Experimental Hepatology 6 (2016): S26-S27.
  5. da Silva Folhadela MR, Fernandes MT, Pereira HC, da Silva EC. "Prospective Study on Predictors of Death in Patients with Alcoholic Hepatitis." Ann Public Health Res 3.4 (2016): 1050.
  6. Papastergiou V, Tsochatzis EA, Pieri G, Thalassinos E, Dhar A, Bruno S, et al. Nine scoring models for short-term mortality in alcoholic hepatitis: cross-validation in a biopsy-proven cohort. Aliment Pharmacol Ther. 2014;39(7):721-32.
  7. Pang JX, Ross E, Borman MA, et al. Risk factors for mortality in patients with alcoholic hepatitis and assessment of prognostic models: A population-based study. Can J Gastroenterol Hepatol. 2015;29(3):131-8.
  8. Mathurin P, Mendenhall CL, Carithers Jr RL, Ramond MJ, Maddrey WC, Garstide P, et al. Corticosteroids improve short-term survival in patients with severe alcoholic hepatitis (AH): individual data analysis of the last three randomized placebo controlled double blind trials of corticosteroids in severe AH. Journal of hepatology. 2002 Apr 1;36(4):480-7.
  9. Mathurin P, O'grady J, Carithers RL, Phillips M, Louvet A, Mendenhall CL, et al. Corticosteroids improve short-term survival in patients with severe alcoholic hepatitis: meta-analysis of individual patient data. Gut. 2010 Jan 1:gut-2010.