A 48-year-old man with a 20-year history of heavy alcohol consumption (approximately 120 g/day) presents with jaundice, fever, and tender hepatomegaly. Laboratory results: total bilirubin 18 mg/dL, prothrombin time 28 seconds (control 12 seconds), WBC 14,500/µL. Which criterion determines the need for corticosteroid therapy in this patient?
- A MELD score > 20
- B Maddrey's Discriminant Function (DF) ≥ 32 ✓
- C AST/ALT ratio > 2 with bilirubin > 10 mg/dL
- D Glasgow Alcoholic Hepatitis Score ≥ 9
Correct answer: B. Maddrey's Discriminant Function (DF) ≥ 32
Explanation
Maddrey's Discriminant Function (DF = 4.6 × [patient PT minus control PT] + bilirubin in mg/dL) identifies severe alcoholic hepatitis when ≥ 32, with 30-50-day mortality around 50% without treatment. Prednisolone 40 mg daily for 28 days is indicated. MELD > 20 also predicts severity but DF is the classic criterion used to initiate corticosteroid therapy. Lille score at day 7 then assesses response.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.