From the Guidelines
A Maddrey's Discriminant Function (MDF) score of 32 or higher indicates futility of corticosteroids and necessitates urgent liver transplantation.
Key Points
- The MDF score is a prognostic score used to assess the severity of alcoholic hepatitis and predict short-term mortality 1.
- A score of 32 or higher indicates severe alcoholic hepatitis and a high risk of short-term mortality, with a 1-month mortality rate of 30%-50% 1.
- In such cases, corticosteroid therapy may not be effective, and urgent liver transplantation may be necessary 1.
- The Lille score, calculated on the 7th day of treatment, can also be used to evaluate the response to corticosteroid therapy and predict survival 1.
- A Lille score of 0.45 or higher indicates a poor response to treatment and a high risk of mortality, and liver transplantation should be considered in these cases 1.
- The combined MELD and Lille scores can be used to select patients with the highest risk of death and prioritize them for liver transplantation 1.
From the Research
Maddrey's Discriminant Function (MDF) Score
- The MDF score is a measure of disease prognosis in alcoholic hepatitis (AH) used to identify patients at highest risk of mortality and determine the need for initiation of pharmacologic treatment 2.
- A score of >32 would predict short term mortality of around 20-30% at 1 month and 30-40% within 6 months after presentation 3.
- The MDF score is commonly followed in clinical practice to guide the clinicians to choose appropriate specific therapy (corticosteroid or pentoxifylline) and as a stopping rule if there is no significant benefits of it 3.
- However, recent studies suggest that the MELD score has better performance in predicting short-term mortality compared to the MDF score 4, 5.
Futility of Corticosteroids and Need for Liver Transplantation
- Corticosteroid therapy represents the main medical treatment that may reduce short-term mortality in severe AH, but it may not be effective in all patients 3, 6.
- The Lille score at day 7 assesses the therapeutic response to steroid therapy, and a score of >0.45 indicates poor responders or >0.56 indicates null responders 3.
- In treatment failure cases, liver transplantation is the ultimate option, and the MDF score can be used to identify patients who may require urgent liver transplantation 3, 6.
- A baseline prothrombin time (BPT) can predict the response to steroid therapy, and patients with higher BPT are more likely to not respond to steroid therapy 6.