A 45-year-old man with heavy alcohol use is hospitalized with jaundice. His PT is 18 seconds (control 12 seconds), and total bilirubin is 8 mg/dL. He has no active infection. What is his Maddrey Discriminant Function score and the most appropriate management?
- A Score 36; start prednisolone 40 mg/day ✓
- B Score 24; supportive care only
- C Score 36; start pentoxifylline 400 mg three times daily
- D Score 48; list for early liver transplant
Correct answer: A. Score 36; start prednisolone 40 mg/day
Explanation
Maddrey DF = 4.6 × (PT - control) + total bilirubin (mg/dL) = 4.6 × 6 + 8 = 35.6 (rounded to 36). B score >32 indicates severe alcoholic hepatitis. Prednisolone 40 mg/day is first-line if there are no contraindications like infection or GI bleeding. Pentoxifylline is not superior to placebo and is not recommended as first-line. Early transplant is considered in select steroid non-responders.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.