DF

Q:  Maddrey discriminant function is a formula to determine the disease severity and mortality risk in patients with alcoholic hepatitis. The calculation of Maddrey 'discriminant' function (DF) includes all EXCEPT? (select one)

A) prothrombin time (sec) 

B) control prothrombin time (sec)

C) serum bilirubin

D) AST/ALT ratio

Answer: D

Maddrey discriminant function is a formula to determine the disease severity and mortality risk in patients with alcoholic hepatitis. 

Discriminant Function = 4.6 * (Pt's PT - Control PT) + TBili

There are two objectives of this question. 

First, to emphasize that the extent of hepatic function is best presented by prothrombin time. That's why AST/ALT ratio is NOT included in this formula (choice D). 

Second, to highlight that why it is called Maddrey 'discriminant' function. Because it helps to discriminate between patients who may benefit from treatment with or without glucocorticoids. Patients with a DF value ≥32 may benefit from glucocorticoid treatment; as such alcoholic patients may have high short-term mortality.

#hepatology

References: 

1. Imperiale TF, McCullough AJ. Do corticosteroids reduce mortality from alcoholic hepatitis? A meta-analysis of the randomized trials. Ann Intern Med 1990; 113:299.

2. Maddrey WC, Boitnott JK, Bedine MS, et al. Corticosteroid therapy of alcoholic hepatitis. Gastroenterology 1978; 75:193.