A 42-year-old man with heavy alcohol intake presents with 2 weeks of jaundice (bilirubin 12 mg/dL), tender hepatomegaly, fever, and leukocytosis. Prothrombin time is prolonged by 8 seconds over control. Which management decision is indicated by his discriminant function?
- A Pentoxifylline 400 mg thrice daily as first-line therapy
- B Prednisolone 40 mg daily for 28 days ✓
- C Antiviral therapy after viral serologies
- D Ursodeoxycholic acid 300 mg twice daily
Correct answer: B. Prednisolone 40 mg daily for 28 days
Explanation
The Maddrey discriminant function equals prothrombin time prolongation in seconds multiplied by 4.6 plus bilirubin in mg/dL. Here it is 36.8 plus 12, well above 32, identifying severe alcoholic hepatitis with 30-day mortality near 30 percent. Corticosteroids are recommended first-line in non-contraindicated patients. Pentoxifylline failed to show benefit over placebo in the STOPAH trial and is no longer preferred.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.