Q: What is Maddrey’s modified Discriminant Function (mDF) and its clinical implication?

 

Answer: American College of Gastroenterology defines severity of alcoholic hepatitis as a modified Discriminant Function(mDF). If score is more or equal to 32 and/or hepatic encephalopathy, it identifies the cutoff for severity. This is calculated as

mDF = 4.6 (PTpatient–PTcontrol)+ serum bilirubin (µmol/l)/17.

mDF more/= 32 and/or hepatic encephalopathy was associated with a 65% 28-day survival in placebo treated patients. While those with a score less than 32 had a survival of 93%.

American College of Gastroenterology recommends prednisolone should be used in patients with severe alcoholic hepatitis ( where mDF more/= 32) in whom the diagnosis is certain.