A 42-year-old man presents with jaundice, tender hepatomegaly, and fever after years of heavy alcohol use. Total bilirubin is 5 mg/dL, prothrombin time 20 seconds with a control of 13 seconds, AST 180 U/L, ALT 70 U/L. What is his Maddrey discriminant function and the appropriate management decision?
- A DF approximately 15, supportive care alone
- B DF approximately 37, corticosteroids indicated ✓
- C DF approximately 27, supportive care alone
- D DF approximately 52, urgent liver transplantation
Correct answer: B. DF approximately 37, corticosteroids indicated
Explanation
Maddrey discriminant function equals 4.6 times the prolongation of prothrombin time above control plus bilirubin in mg/dL. Here it is 4.6 multiplied by 7, which gives 32.2, plus 5, giving about 37. A value of 32 or more identifies severe alcoholic hepatitis with 30-day mortality around 30 to 50 percent and is the standard threshold for prednisolone 40 mg daily. Transplantation is not offered acutely without abstinence and failed medical therapy.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.