Modified Maddrey's discriminant function (mDF)
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Modified Maddrey's discriminant function
(Score) is a predictive statistical model useful for evaluating
the severity and prognosis in alcoholic hepatitis1 (especially
mortality within 30 days)2 and evaluates the efficacy of using
alcoholic hepatitis steroid treatment.
Requirements: Patient's prothrombin time and a control value
along with the current bilirubin level.
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Prothrombin Time (PT) - Patient:
sec
[Normal: 11 - 13.5]
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Prothrombin Time (PT) - Control:
sec
[Normal: 11 - 13.5]
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Serum Total Bilirubin:
[Normal: < 1.2 mg/dL (0.1 -1.2 mg/dL)]
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Background Info
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The modified Maddrey's discriminant function) was originally described by
Maddrey and Boitnott1 to predict prognosis in alcoholic hepatitis.
Equation:
mDF=
(4.6 x (PT test - control))+ serum bilirubin (mg/dl)
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Interpretation:
A value more than 32 implies poor outcome with one month mortality ranging
between 35% to 45%.3
Corticosteroid therapy or pentoxifylline have been used with mixed results for
patients whose increased mortality is indicated with a value greater than 32.4
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References
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1.
Maddrey WC, Boitnott JK, Bedine MS, Weber FL Jr, Mezey E, White RI Jr.
Corticosteroid therapy of alcoholic hepatitis.
Gastroenterology. 1978 Aug;75(2):193-9.
2.
Sheth M, Riggs M, Patel T. "Utility of the Mayo End-Stage Liver Disease
(MELD) score in assessing prognosis of patients with alcoholic hepatitis".
BMC Gastroenterol. 2002; 2: 2.. doi:10.1186/1471-230X-2-2. PMID
11835693.
3. Akriviadis E1, Botla R, Briggs W, Han S, Reynolds T, Shakil O.
Pentoxifylline improves short-term survival in severe acute alcoholic
hepatitis: a double-blind, placebo-controlled trial.
Gastroenterology. 2000 Dec;119(6):1637-48.
4.
Mathurin P, O'Grady J, Carithers RL, Phillips M, Louvet A, Mendenhall CL,
Ramond MJ, Naveau S, Maddrey WC, Morgan TR.
Corticosteroids improve short-term survival in patients with severe alcoholic
hepatitis: meta-analysis of individual patient data.
Gut. 2011 Feb;60(2):255-60.
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