A 42-year-old man presents with 2 weeks of jaundice and tender hepatomegaly after heavy alcohol intake. AST 180 U/L, ALT 62 U/L, bilirubin 12 mg/dL, prothrombin time 22 seconds (control 13 seconds). Which management decision is guided by his Maddrey discriminant function?

• A Immediate referral for liver transplantation
• B Cholecystectomy for suspected cholecystitis
• C Antiviral therapy with tenofovir
• D Commencement of oral prednisolone ✓

Explanation

The Maddrey discriminant function is calculated as 4.6 multiplied by (patient prothrombin time minus control) plus bilirubin in mg/dL. Here it equals 4.6 times 7 plus 12, giving about 44. A value above 32 identifies severe alcoholic hepatitis with high short-term mortality, for which prednisolone improves survival. The AST to ALT ratio exceeding 2 with both values below 400 supports alcoholic rather than viral injury, making antivirals inappropriate.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.