A 45-year-old man with heavy alcohol use presents with jaundice, fever, and tender hepatomegaly. Total bilirubin is 12 mg/dL, prothrombin time 22 seconds (control 12 seconds). Which scoring system is used to determine the need for corticosteroid therapy in this condition?
- A Child-Pugh score
- B Maddrey's discriminant function ✓
- C MELD score
- D Lille score
Correct answer: B. Maddrey's discriminant function
Explanation
Maddrey's discriminant function (DF = 4.6 × [PT difference in seconds] + bilirubin in mg/dL) assesses alcoholic hepatitis severity. A DF of 32 or higher indicates severe disease and predicts benefit from corticosteroid therapy. The Lille score is used at day 7 to assess response to steroids, not for the initial treatment decision. Child-Pugh and MELD assess cirrhosis severity, not alcoholic hepatitis treatment thresholds.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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