Maddrey’s Discriminant Function Calculator

If you need to evaluate the short-term prognosis of alcoholic hepatitis of patients by measuring Maddrey score, check out our simple yet useful Maddrey’s Discriminant Function Calculator.

Do you want to explore more health-related calculators?

For evaluating how addicted you are to nicotine, check out our HSI Calculator. We also have built a calculator for measuring the venous thromboembolism risk factors; thus, head over to our PADUA Score Calculator. Additionally, if you would like to learn how to treat and take care of patients who have cirrhosis and measure its severity level, use the Child Pugh Calculator.

Alcoholic Hepatitis

When a person drinks a massive amount of alcohol over a certain period, his/her liver starts inflaming, causing a medical disease called alcoholic hepatitis.

Mostly, it occurs to people with heavy drinking addiction, but we cannot claim such a thing with certainty because there are many other factors. However, heavy drinkers are constantly at a high risk of serious liver damage and a high mortality rate.

These are some most common symptoms of this disease:

• Loss of appetite
• Nausea and vomiting
• Abdominal tenderness
• Fever, often low grade
• Fatigue and weakness

How much alcohol do you need to drink in order to expose yourself to getting your liver damaged? Unfortunately, you can’t answer this question with certainty because there is no universal drinking rate at which you are risking your life. However, according to the stats, people with a history of drinking more than 100 grams. It is an equivalent to 7 glasses of wine and 7 beers every day for the last 20 years, which is considered a group with highly damaged livers.

Does it mean that you are safe if you have drunk alcohol for less than 20 years? Of course, not. Alcoholic hepatitis can occur in any group of people. Check if you have alcohol-related problem with this Audit-C Calculator.

Alcoholic Hepatitis vs. Cirrhosis

What is alcoholic hepatitis, and in what relation is it to cirrhosis?

Both hepatitis and cirrhosis are very serious diseases in the first place. Secondly, they affect the same organ – an individual’s liver. Moreover, if we look at their symptoms, we will find out that they have many similar symptoms. However, it does not mean they are the same or represent the same thing.

According to the studies, there is some chance to cure hepatitis. In comparison, cirrhosis is the permanent injury or damage to the liver, and there is no single medicament or means to cure it.

Considering their similarities, both of them are likely to cause liver cancer or failure.

Comparison:

• Normally liver enzymes get elevated with hepatitis, whereas liver function tests may be slightly abnormal with cirrhosis.
• For hepatitis, the goal is usually to alleviate the disease, e.g., treat the infection. On the other hand, cirrhosis cannot be cured; therefore, the goal is always to prevent further liver injury.
• Portal hypertension, which leads to a low protein level in the blood and many other serious health issues, is more likely to occur with cirrhosis than with hepatitis.

Maddrey’s Discriminant Function – MDF

Maddrey Discriminant Function (MDF) is used to evaluate the severity and prediction of the liver disease. Additionally, it can assess which patients are likely to benefit from steroid therapy.

In the calculation of Maddrey’s assessment score, there are only three variables used:

• RT prothrombin time
• patient’s actual prothrombin time
• serum bilirubin level

Origin

Going back to 1978, doctor Willis Maddrey and his colleagues built a discriminant function used today to evaluate the short-term prognosis of alcoholic hepatitis. 

Maddrey is a widely known doctor who currently works as a professor of internal medicine in Dallas. He has already published many internal medicine articles on various topics such as alcohol-induced liver disease, liver transplantation, and many others.

Maddrey Score Formula

Let’s find out how to calculate Maddrey score using Maddrey’s formula below:

\text{Maddrey score (MDF) = 4.6} \times \text{(PT - reference PT) + bilirubin}

where:

PT – patient’s prothrombin time in seconds
reference PT – reference PT time, usually 11-13 seconds
bilirubin – total bilirubin’s level in mg/dl (you can choose different units)

Prothrombin Time

Prothrombin is a protein that your liver produces. In calculating the alcoholic hepatitis score, we mentioned three variables. Therefore, one of the three variables is a prothrombin time (PT). PT test measures how much time the liquid portion of your blood needs to clot. Additionally, it tells you at what speed your blood clots. 

Prothrombin time test results are given in an INR (international normalized ratio) measurement.

The normal (standard) range for clotting is:

• 11 to 13.5 seconds
• INR of 0.8 to 1.1

Bilirubin Levels

Another variable that plays a crucial role in measuring the Maddrey’s score is bilirubin levels. However, to understand it, first, we need to break down what it is.

What is bilirubin?

We get bilirubin during the breakdown of red blood cells. It is a pigment with yellowish color that passes through the liver and is eventually discharged out of the body.

What is bilirubin testing used for?

We also use not a single but a group of bilirubin tests to check the health of your liver. For example, if you have a lower bilirubin level, you should not worry because your liver is safe. On the contrary, elevated (high) levels indicate that your liver is most likely damaged.

Maddrey Score Interpretation

We have already tackled questions like “what is Maddrey score” and “how to calculate Maddrey’s score”. But, how do we interpret the score and know what the score value tells us?

Generally, there are two interpretations:

MDF score < 32

If patients score a value less than 32, it indicates the existence of mild or moderate alcoholic hepatitis.

If you ever have mild liver damage, these are some medical tips you should follow: 

• eat healthy (rich nutrients)
• you should avoid alcohol completely

MDF score >= 32

If patients score a value equal to or greater than 32, it indicates severe alcoholic hepatitis.

Maddrey’s Discriminant Function Calculator – How to Use?

To evaluate the prognosis of alcoholic hepatitis, we have specially developed Maddrey’s Discriminant Function Calculator. It’s a handy and practical tool, and all you are required to do is enter the value for the three variables: PT, reference PT and bilirubin level of a patient, and our calculator will do the rest.

Ultimately, MDF Calculator will return the Maddrey’s score and prediction of alcoholic hepatitis for an individual.

If you had a hard time navigating through the calculator and cannot figure out how to use it, follow the steps below:

Steps:

• Enter the prothrombin time (it is usually between 11 and 13 seconds)
• Enter the reference PT
• Specify bilirubin’s level in mg/dL

Note: Similarly, you can calculate the MELD score for a patient to predict the mortality risk and case urgency (therapy). Additionally, MELD score tell you if or when a patient needs liver transplant.

Maddrey’s Discriminant Function Calculator – Example

Now, let’s show how to practically utilize the power of Maddrey’s Discriminant Function Calculator and evaluate the prediction of alcoholic hepatitis for a particular patient.

Scenario: Check the hepatitis status for an imaginary patient with a bilirubin level of 1.8 mg/dL, prothrombin time – 15 seconds, and reference PT – 11 seconds.

Steps:

1. Input all the parameters in the calculator
2. The calculator returns MDF score, which is equal to 20.2
3. The MDF score of 20.2 indicates a good prognosis of alcoholic hepatitis

If you want to evaluate the prognosis for different bilirubin levels and prothrombin time, feel free to explore Maddrey’s Discriminant Function Calculator in depth.

FAQ