What is the Maddrey score (Model for End-Stage Liver Disease score)?

From the Guidelines

The Maddrey Discriminant Function (MDF) is a scoring system used to assess the severity of alcoholic hepatitis and predict short-term mortality, calculated using the formula: 4.6 × (patient's prothrombin time - control prothrombin time in seconds) + total bilirubin (mg/dL), with a score of 32 or higher indicating severe disease and poor prognosis. The MDF score is a widely used and well-established tool for predicting short-term mortality in patients with alcoholic hepatitis, with a score of 32 or higher indicating a high risk of mortality, approximately 30-50% within 30 days if untreated 1.

Key Components of the MDF Score

• Prothrombin time (PT): reflects liver synthetic function
• Total bilirubin: reflects liver excretory function

Interpretation of the MDF Score

• A score of 32 or higher indicates severe alcoholic hepatitis with a poor prognosis
• Patients with scores above this threshold are typically considered for corticosteroid therapy, specifically prednisolone 40mg daily for 28 days, which may improve survival in selected patients 1

Limitations and Additional Considerations

• The MDF score is not perfect and may not accurately predict mortality in all patients
• Other scoring systems, such as the MELD score and the Glasgow Alcoholic Hepatitis Score (GAHS), may also be useful in predicting short-term mortality in patients with alcoholic hepatitis 1
• Response to steroids should be assessed after 7 days using other tools like the Lille score, as not all patients with high MDF scores benefit from continued steroid treatment 1

From the Research

Definition of Maddrey Score and MELD Score

• The Maddrey score, also known as Maddrey's discriminant function (MDF), is a prognostic model used to predict short-term mortality in patients with alcoholic hepatitis 2, 3.
• The Model for End-Stage Liver Disease (MELD) score is a scoring system used to predict mortality in patients with end-stage liver disease, including those with alcoholic hepatitis 4, 5, 3, 6.

Calculation and Interpretation of Scores

• The MDF score is calculated based on serum bilirubin and prothrombin time, with a score of >32 predicting short-term mortality of around 20-30% at 1 month and 30-40% within 6 months after presentation 2.
• The MELD score is calculated based on serum bilirubin, serum creatinine, and international normalized ratio (INR), with higher scores indicating higher mortality risk 4, 5, 3.
• A MELD score of 21 has been shown to have a sensitivity of 75% and a specificity of 75% in predicting 90-day mortality in patients with alcoholic hepatitis 4.

Comparison of MDF and MELD Scores

• Studies have compared the predictive value of MDF and MELD scores in patients with alcoholic hepatitis, with some showing that MDF is a more valuable model for predicting short-term mortality 3.
• Other studies have found that MELD is useful for predicting 30-day and 90-day mortality in patients with alcoholic hepatitis, and maintains some practical and statistical advantages over MDF 4.
• However, another study found that MELD score was not significant for predicting 90-day mortality, while CTP score was statistically significant 5.

Clinical Application of Scores

• Both MDF and MELD scores are used to guide treatment decisions and predict mortality in patients with alcoholic hepatitis 2, 4, 6.
• The scores can help identify patients who may benefit from corticosteroid therapy or liver transplantation 2, 6.