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Modified Maddrey’s discriminant function (mDF)

Modified Maddrey's discriminant function  (mDF)
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.   
 

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)]

Background Info

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

References

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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