A 45-year-old man with acute alcoholic hepatitis has a total bilirubin of 18 mg/dL and prothrombin time 22 seconds (control 12 seconds). Which score is used to determine corticosteroid eligibility, and what is the threshold indicating severe disease requiring treatment?

• A ABIC score; score >9
• B MELD score; score >20
• C Child-Pugh score; class C
• D Maddrey Discriminant Function; score >32 ✓

Explanation

The Maddrey Discriminant Function (DF = 4.6 x prothrombin time difference + total bilirubin in mg/dL) identifies severe alcoholic hepatitis. D DF >32 indicates severe disease with high short-term mortality and is the threshold for corticosteroid therapy (prednisolone 40 mg/day for 28 days). MELD >20 also identifies severe disease and can be used as an alternative, but the Maddrey DF is the classic and most widely tested threshold for steroid initiation in Indian exams.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.