A 48-year-old man with heavy alcohol use (120 g/day for 15 years) presents with jaundice, fever, tender hepatomegaly, and leukocytosis. Total bilirubin is 18 mg/dL, AST 280 U/L, ALT 90 U/L (AST:ALT ratio >2), INR 1.8, and creatinine 1.1 mg/dL. Which calculation is most appropriate to determine the need for corticosteroid therapy?

• A Child-Pugh score
• B Maddrey Discriminant Function (mDF) ✓
• C MELD score alone
• D APRI score

Explanation

The Maddrey Discriminant Function (4.6 × [patient's PT − control PT] + total bilirubin in mg/dL) identifies severe alcoholic hepatitis (mDF ≥32), where prednisolone reduces short-term mortality. Child-Pugh and MELD are prognostic in cirrhosis but not the decision tool for corticosteroid initiation in acute alcoholic hepatitis. APRI is a non-invasive fibrosis marker. A mDF ≥32 with no gastrointestinal bleeding or infection is the standard indication for corticosteroids.

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

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