A 52-year-old man with a history of heavy alcohol use (80 g/day for 20 years) presents with jaundice, fever, and right upper quadrant pain. Total bilirubin is 18 mg/dL, AST 220 IU/L, ALT 80 IU/L, INR 2.1, WBC 18,000/mm3. AST:ALT ratio is >2:1. Which scoring system is used to determine the need for corticosteroid therapy in this condition?

• A Maddrey Discriminant Function ✓
• B MELD score
• C Child-Pugh score
• D APRI score

Explanation

The Maddrey Discriminant Function (DF = 4.6 x prothrombin time difference + total bilirubin in mg/dL) identifies severe alcoholic hepatitis (DF >32), which carries high mortality and predicts benefit from corticosteroid therapy. The AST:ALT ratio >2:1 with AST typically <300 IU/L is characteristic of alcoholic hepatitis. Child-Pugh and MELD assess cirrhosis severity, not alcoholic hepatitis treatment decisions. APRI is a non-invasive fibrosis marker.

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

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