Maddrey's Discriminant Function

Severity of alcohol-associated hepatitis and the threshold for corticosteroids
Patient prothrombin time (seconds)
Control / laboratory prothrombin time (seconds)
Total bilirubin
Enter the prothrombin times and bilirubin to calculate
Evidence
Original publication
Maddrey WC, Boitnott JK, Bedine MS, Weber FL Jr, Mezey E, White RI Jr. Corticosteroid therapy of alcoholic hepatitis. Introduced the discriminant function combining prothrombin time and bilirubin; patients with a high value had substantial short-term mortality and appeared to benefit most from corticosteroids.
Gastroenterology, 1978
Open source
Validation
Carithers RL Jr, Herlong HF, Diehl AM, et al. Methylprednisolone therapy in patients with severe alcoholic hepatitis. Used the modified discriminant function 4.6·(PT − control) + bilirubin with a threshold of 32 to define severe disease; corticosteroids reduced 28-day mortality in that group.
Annals of Internal Medicine, 1989
Open source
Guideline
AASLD and EASL guidance use mDF ≥ 32 (or MELD > 20) to identify severe alcohol-associated hepatitis for consideration of corticosteroids, with the Lille score at day 7 used to decide whether to continue them.
Last reviewed: 2026-09
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