Patients with severe alcoholic hepatitis can have a high short-term mortality. Corticosteroid therapy can reduce this mortality in patients with spontaneous hepatic encephalopathy or an elevated discriminant function based on the patient's prothrombin time and serum bilirubin.
Maddrey et al developed a discriminant function to identify a patient with alcoholic hepatitis who may benefit from corticosteroid therapy. This was later modified by Carithers et al who used methylprednisolone to treat the patients.
Timing: The score is calculated between 7 to 12 days after hospital admission.
Parameters:
(1) patient's prothrombin time in seconds
(2) prothrombin time of normal control in seconds
(3) serum bilirubin in mg/dL)
discriminant function of Maddrey et al =
= (4.6 * (patient's prothrombin time in seconds)) + (serum bilirubin in mg/dL)
modified discriminant functi>
= (4.6 * ((patient's prothrombin time in seconds) - (prothrombin time of normal control in seconds))) + (serum bilirubin in mg/dL)
where:
• A serum bilirubin in µmol/L can be converted to mg/dL by dividing by 17.1.
Interpretation:
• If the original discriminant function is > 93, then the patient has a significant risk of early mortality (28-day survival 25%). A score <= 93 is associated with 28-day survival rate of 100%. The former patient may benefit from corticosteroid therapy.
• If the modified discriminant function is > 32, then the patient has a significant risk of early mortality (28-day survival 65%). The patient may benefit from methylprednisolone therapy, with reduced mortality over the next month. A score <= 32 is associated with 28-day survival of 93%.
