What is the diagnosis and treatment for Mdf (Medical Diagnosis/Condition or Medication)?

Maddrey Discriminant Function (MDF) in Alcoholic Hepatitis

What is MDF?

The Maddrey Discriminant Function (MDF) is a prognostic scoring system used to assess disease severity and guide treatment decisions in alcoholic hepatitis (AH), with an MDF score >32 indicating severe disease that warrants consideration for corticosteroid therapy. 1

The MDF score is calculated using the following formula:

• MDF = 4.6 × (patient's prothrombin time - control prothrombin time) + serum bilirubin (mg/dL) 1

Clinical Application and Interpretation

Severity Stratification

• MDF >32 defines severe alcoholic hepatitis and identifies patients at high risk of short-term mortality who may benefit from specific medical interventions 1
• MDF <32 indicates mild to moderate disease where patients typically do not require nor benefit from specific medical interventions beyond nutritional support and abstinence 1

Treatment Decisions Based on MDF

For patients with MDF >32 (severe disease):

• Consider prednisolone 40 mg/day for 28 days (typically followed by discontinuation or a 2-week taper) if no contraindications to corticosteroids exist 1
• Contraindications to glucocorticoids include hepatitis B viral infection, tuberculosis, or other serious infectious diseases 1
• If contraindications to steroids exist, consider pentoxifylline 400 mg orally three times daily for 4 weeks, though data regarding efficacy are conflicting 1
• Patients with MELD score >26 (often correlating with high MDF) with good insight into alcohol use disorder and good social support should be referred for liver transplantation evaluation, as 90-day mortality is very high 1

For patients with MDF <32 (mild to moderate disease):

• Refer for abstinence counseling 1
• Prescribe high protein diet (1-1.5 g protein and 30-40 kcal/kg body weight) supplemented with B vitamins and folic acid 1
• Close monitoring without specific pharmacologic interventions 1

Important Limitations of MDF

Recent evidence demonstrates that the MELD score is superior to MDF for predicting short-term mortality in alcoholic hepatitis. A global study of 2,581 patients showed that the area under the receiver operating characteristic curve for 28-day mortality was significantly lower for MDF (0.701) compared to MELD (0.773), suggesting that MDF should no longer be the primary score used to assess AH prognosis 2

Despite this limitation, MDF remains embedded in clinical practice guidelines as one of several acceptable scoring systems for severity assessment 1

Essential Supportive Management Regardless of MDF Score

• Absolute abstinence from alcohol is the cornerstone of treatment 1
• Obtain cultures of blood, urine, and ascites (if present) to determine presence of bacterial infections regardless of fever 1
• Admit patients with severe AH or inadequate social/medical support to hospital 1
• Avoid nephrotoxic drugs including diuretics, as acute kidney injury is an early manifestation of multi-organ failure 1
• Monitor for systemic inflammatory response syndrome (SIRS), which is associated with increased risk of multi-organ failure and very high mortality 1

Common Pitfalls

• Failing to assess for infection before initiating corticosteroids, as infections developing after AH diagnosis are associated with multi-organ failure and very high mortality 1
• Using MDF alone without considering MELD score, which has superior prognostic accuracy 2
• Continuing corticosteroids beyond 28 days, as methylprednisolone does not improve survival beyond this timeframe and benefits for <28 days are modest 1
• Neglecting nutritional support, which is necessary for recovery and should include enteral feeding via feeding tube if oral intake is inadequate 1