What are the Maddrey's Discriminant Function (MDF) and Model for End‑Stage Liver Disease (MELD) scores for a patient with total bilirubin 7 mg/dL, BUN 6 mg/dL, creatinine 0.5 mg/dL, INR 1.3, and prothrombin time 13.7 seconds (control 12.5 seconds)?

Calculated Scores for Your Patient

Your patient has a Maddrey Discriminant Function (MDF) of 12.5 and a Model for End-Stage Liver Disease (MELD) score of approximately 9, both indicating non-severe alcoholic hepatitis that does NOT meet the threshold for corticosteroid therapy.

MDF Calculation

Using the formula: MDF = 4.6 × (Patient PT – Control PT) + Total Bilirubin (mg/dL) 1

• Patient PT: 13.7 seconds
• Control PT: 12.5 seconds
• Total bilirubin: 7 mg/dL

MDF = 4.6 × (13.7 – 12.5) + 7 = 4.6 × 1.2 + 7 = 5.52 + 7 = 12.52 2

MELD Calculation

Using the formula: MELD = 3.8 × log(bilirubin mg/dL) + 11.2 × log(INR) + 9.6 × log(creatinine mg/dL) + 6.4 1

• Bilirubin: 7 mg/dL
• INR: 1.3
• Creatinine: 0.5 mg/dL

MELD = 3.8 × log(7) + 11.2 × log(1.3) + 9.6 × log(0.5) + 6.4
MELD = 3.8 × 0.845 + 11.2 × 0.114 + 9.6 × (–0.301) + 6.4
MELD = 3.21 + 1.28 – 2.89 + 6.4 = 8.0 2, 1

Clinical Interpretation

Disease Severity Classification

• MDF of 12.5 is well below the threshold of 32 that defines severe alcoholic hepatitis, indicating this patient has non-severe disease with a predicted one-month mortality risk of less than 10% 2
• MELD of 8–9 falls in the low-risk range, far below the threshold of 18–21 that signals poor prognosis in alcoholic hepatitis 2, 1

Treatment Implications

• Corticosteroid therapy (prednisolone 40 mg daily) is NOT indicated because both MDF < 32 and MELD < 20 3, 1
• The American Association for the Study of Liver Diseases reserves corticosteroid treatment for patients with MDF ≥ 32 or MELD > 20, neither of which applies here 3, 1

Management Priorities

• Alcohol abstinence counseling is the cornerstone of therapy and should be initiated immediately, as abstinence is the main determinant of long-term prognosis even in non-severe disease 2
• Aggressive nutritional support with enteral therapy should be provided, particularly targeting 35–40 kcal/kg/day with 1.2–1.5 g/kg/day protein 2, 3
• B-complex vitamin supplementation (especially thiamine) is recommended to prevent Wernicke's encephalopathy 2
• Close monitoring remains essential because even "moderate" alcoholic hepatitis (MDF < 32) carries a 10% six-month mortality and 20% one-year mortality 4

Important Caveats

• The control PT of 12.5 seconds used in your MDF calculation is appropriate and represents a standard laboratory value; however, be aware that different control PT values (ranging from 12 to 14.8 seconds) can shift the proportion of patients meeting the MDF ≥ 32 threshold by 18–20%, though this does not affect actual survival outcomes 5
• MELD may be more accurate than MDF for predicting 30-day mortality in alcoholic hepatitis (AUROC 0.767 vs. 0.735), so the low MELD score provides additional reassurance about short-term prognosis 5
• Despite the favorable scores, screen for and treat complications including hepatic encephalopathy, ascites, and infection, as these independently impact outcomes 2