From the Guidelines
The Alcoholic Hepatitis Score, commonly known as the Maddrey's Discriminant Function (MDF), is a clinical tool used to assess the severity of alcoholic hepatitis and guide treatment decisions, with a score of 32 or higher indicating severe disease and high short-term mortality risk. To calculate this score, use the formula: MDF = 4.6 × (patient's prothrombin time - control prothrombin time) + total bilirubin (mg/dL) 1. According to the most recent guidance, prednisolone (40 mg/day) given orally should be considered to improve 28-day mortality in patients with severe AH (MDF ≥32) without contraindications to the use of corticosteroids 1.
Key Points to Consider
- The MDF score is a crucial tool in assessing the severity of alcoholic hepatitis and guiding treatment decisions 1.
- A score of 32 or higher indicates severe alcoholic hepatitis with high short-term mortality risk, typically warranting consideration of corticosteroid therapy such as prednisolone 40mg daily for 28 days 1.
- Other scoring systems for alcoholic hepatitis include the MELD (Model for End-Stage Liver Disease) score, Glasgow Alcoholic Hepatitis Score, and Lille score, which can help clinicians objectively assess disease severity and predict outcomes 1.
- Complete abstinence from alcohol remains the cornerstone of management regardless of disease severity, and addressing malnutrition with enteral nutrition is also crucial 1.
Treatment Considerations
- Prednisolone (40 mg/day) is recommended for patients with severe AH (MDF ≥32) without contraindications to the use of corticosteroids 1.
- The Lille score should be used to reassess prognosis, identify nonresponders, and guide treatment course after 7 days of corticosteroids 1.
- Pentoxifylline is no longer recommended in the treatment of AH, according to the latest guidance 1.
From the Research
Alcoholic Hepatitis Score
The alcoholic hepatitis score is a measure used to assess the severity and prognosis of alcoholic hepatitis. There are several scoring systems used, including:
- Maddrey's discriminant function score 2, 3, 4, 5, 6
- Model for End-Stage Liver Disease (MELD) score 2, 5, 6
- Lille's score 2
Scoring Systems
The Maddrey's discriminant function score is calculated using a formula that takes into account the patient's bilirubin and prothrombin time levels, and is used to identify patients with severe alcoholic hepatitis who are at high risk of mortality 3, 4. A score of 32 or higher indicates severe disease. The MELD score is a measure of liver disease severity that takes into account the patient's bilirubin, creatinine, and prothrombin time levels, and is used to predict mortality in patients with liver disease 5, 6. A score of 21 or higher indicates severe disease.
Prognosis and Mortality
Studies have shown that patients with severe alcoholic hepatitis, as defined by a Maddrey's discriminant function score of 32 or higher or a MELD score of 21 or higher, have a high risk of mortality, with 3-month mortality rates ranging from 30-70% 2. The prognosis and mortality of patients with alcoholic hepatitis can be estimated using these scoring systems, and can guide decision making for treatment, including corticosteroid therapy and liver transplantation 2, 3, 6.
Key Findings
- The Maddrey's discriminant function score and MELD score are both useful for assessing the severity and prognosis of alcoholic hepatitis 5, 6.
- A Maddrey's discriminant function score of 32 or higher or a MELD score of 21 or higher indicates severe disease and a high risk of mortality 2, 3, 5.
- Patients with severe alcoholic hepatitis have a high risk of mortality, with 3-month mortality rates ranging from 30-70% 2.
- The Lille's score is also used to assess the severity and prognosis of alcoholic hepatitis, and can be used in combination with the Maddrey's discriminant function score and MELD score to guide decision making for treatment 2.