The Maddrey score is also called the Maddrey discriminant function, MDF, mDF, DFI or just DF. It’s one of several tools or calculations doctors can use to determine the next step of treatment based on the severity of alcoholic hepatitis.
Alcoholic hepatitis is a type of alcohol-related liver disease. It’s caused from drinking too much alcohol. Up to 35 percent of heavy drinkers develop this condition. It causes inflammation, scarring, fatty deposits, and swelling of the liver. It also increases the risk of liver cancer and kills liver cells. It can be mild, moderate, or severe.
The MDF score is also considered a prognostic tool because it helps determine who may be a good candidate to receive corticosteroid treatment. It also predicts the likelihood of survival within the next month or several months.
Mild vs. severe alcoholic hepatitis
Mild alcoholic hepatitis can last for years. Up to a certain point, you may be able to reverse damage to your liver over time if you stop drinking. Otherwise, the damage to your liver will continue to get worse and become permanent.
Alcoholic hepatitis can quickly become severe. For instance, it may occur after binge drinking. It can lead to life-threatening complications. It may even lead to death without aggressive management. The Maddrey tool helps your doctor quickly recognize the severity of alcoholic hepatitis.
What other scores may be used?
The MDF score is a commonly used scoring tool. The model for end-stage liver disease (MELD) score is another commonly used tool. Some of the other scoring systems include:
- Glasgow alcoholic hepatitis score (GAHS)
- Child-Turcotte-Pugh score (CTP)
- ABIC score
- Lille score
How is the MDF score calculated?
To calculate the MDF score, doctors use your prothrombin time. It’s one of the tests that measures how long it takes your blood to clot.
The score also uses your serum bilirubin level. That’s the amount of bilirubin present in your bloodstream. Bilirubin is a substance found in bile. Bilirubin is the substance that forms when the liver breaks down old red blood cells. In a person with liver disease, this number is often high.
People with an MDF score of less than 32 are often considered to have mild to moderate alcoholic hepatitis. People with this score are considered to have a lower chance of death in the next few months. Typically, about 90 to 100 percent of people are still living 3 months after receiving the diagnosis.
People with an MDF score equal to or greater than 32 have severe alcoholic hepatitis. People with this score are considered to have a higher chance of death in the next few months. About 55 to 65 percent of people with this score are still living 3 months after diagnosis. Aggressive management and a younger age may improve the outlook.
How do doctors use the Maddrey score?
Your doctor will often determine a treatment plan based on your MDF score and other factors. They may recommend hospitalization so that they can closely monitor your condition. During hospitalization, your doctor will often:
- Closely monitor your liver function to see if the levels improve.
- Treat any complications related to alcohol-related liver disease.
- Use other scoring tools or calculate your MELD score. This uses your bilirubin, creatinine, and international normalized ratio (INR) result, which is based on your prothrombin time. It helps your doctor further evaluate your condition. A MELD score of 18 and higher is associated with a poorer outlook.
- Perform imaging tests like an ultrasound and a liver biopsy if needed.
- Support you through alcohol withdrawal, if necessary.
- Talk with you about the importance of abstinence, or not drinking alcohol, for the rest of your life. It’s not safe for you to drink any amount of alcohol if you have alcoholic hepatitis.
- Refer you to an alcohol and drug abuse program, if necessary.
- Talk with you about your social support for staying away from alcohol.
If your MDF score is lower than 32
An MDF score less than 32 means you likely have mild to moderate alcoholic hepatitis.
Treatment for mild or moderate alcoholic hepatitis includes:
- nutritional support, since malnutrition can be a complication of alcoholic hepatitis
- complete abstinence from alcohol
- close supportive and follow-up care
If your MDF score is higher than 32
An MDF score equal to or greater than 32 means you likely have severe alcoholic hepatitis. You may be a candidate for corticosteroid therapy or pentoxifylline treatment.
Your doctor will consider risk factors that may make it unsafe for you to take corticosteroids. The following factors may increase your risk:
- You’re older than age 50.
- You have uncontrolled diabetes.
- You’ve had an injury to your kidneys.
- You have high levels of bilirubin that don’t decrease soon after you’re hospitalized.
- You still drink alcohol. The more you drink, the higher your risk of death.
- You have a fever, upper gastrointestinal bleeding, pancreatitis, or a kidney infection. Any of these may mean you can’t safely take corticosteroids.
- You have signs of hepatic encephalopathy, which include confusion. This is one of the most dangerous complications of alcoholic hepatitis.
Treatment recommendations for severe alcoholic hepatitis can involve:
- Nutritional support with enteral feeding, also called tube feeding. Nutrients in fluid form deliver nutrition directly to the stomach or small intestine by a tube. Parenteral nutrition is given by vein. Complications of alcoholic hepatitis often determine which type of nutritional support is best.
- Treatment with corticosteroids like prednisolone (Prelone, Predalone). You may need to take this drug over a period of time.
- Treatment with pentoxifylline (Pentoxil, Trental), may be an option depending on your particular condition.
The Maddrey score is a tool your doctor may use to help develop a treatment plan for alcoholic hepatitis. This score helps your doctor understand how severe your condition is. Your doctor will likely also monitor you for other complications, such as gastrointestinal bleeding, pancreatitis, or kidney failure.
Early, aggressive management can improve the outlook for people with this condition, especially if you have severe alcoholic hepatitis.