A 48-year-old man with heavy alcohol use presents with jaundice, ascites, and confusion. Labs show total bilirubin 22 mg/dL and prothrombin time prolonged by 7 seconds compared to control. Which calculation is most critical to guide the decision to initiate corticosteroid therapy?
- A Child-Pugh score
- B MELD score
- C Maddrey Discriminant Function ✓
- D Lille model
Correct answer: C. Maddrey Discriminant Function
Explanation
The Maddrey Discriminant Function identifies severe alcoholic hepatitis. A score greater than 32 indicates severe disease with high short-term mortality, which guides the decision to initiate corticosteroids. The Child-Pugh and MELD scores assess chronic liver disease prognosis but do not dictate the acute indication for steroids. The Lille model assesses response to steroids after 7 days of therapy, not the initial decision to treat.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.