A 48-year-old man with a 15-year history of heavy alcohol intake (approximately 80 g/day) presents with jaundice, fever, and tender hepatomegaly. Labs show total bilirubin 12 mg/dL, AST 280 U/L, ALT 90 U/L, AST:ALT ratio 3.1, PT 22 seconds (control 12 seconds), and WBC 16,000/mm3. Which calculation is used to determine the need for corticosteroid therapy in this patient?
- A Maddrey discriminant function (DF) ✓
- B MELD score
- C Child-Pugh score
- D Lille score
Correct answer: A. Maddrey discriminant function (DF)
Explanation
This patient has severe alcoholic hepatitis (bilirubin >3, prolonged PT, leukocytosis). The Maddrey DF = 4.6 × (patient PT − control PT) + bilirubin (mg/dL) is used at admission to assess severity and guide corticosteroid therapy (DF ≥32 indicates severe disease and benefit from prednisolone). The Lille score is used at day 7 to assess response to steroids, not for the initial treatment decision. Child-Pugh and MELD prognosticate cirrhosis but do not specifically guide steroid initiation in alcoholic hepatitis.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.