Maddrey Score for Alcoholic Hepatitis Calculator

How does this Maddrey score for alcoholic hepatitis calculator work?

This is a health tool also known as the Maddrey’s discriminant function (DF) that predicts the outcome, mortality risk in one month, in patients suffering from alcohol-related hepatitis and also identifies cases in which steroid therapy is recommended.

The three factors used by the Maddrey score for alcoholic hepatitis calculator that are used in risk stratification are explained below:

■ Prothrombin time measured in seconds – indicative of the liver function as reflected in how long it takes for blood (plasma to be exact) to clot. Also often given as the INR (international normalized ratio) result directly. Normal range is between 11 to 13.5 seconds in patients that are not under blood thinning medication such as warfarin.

■ Control time measured in seconds – differs based on each medical laboratory specifications and is usually between 10 and 14 seconds.

■ Bilirubin – reflecting the metabolic function of the liver, usually elevated in cases of alcoholic liver disease. For convenience, the user can choose the measurement system either SI or US therefore can input serum bilirubin in either mg/dL or μmol/L

The two formulas adapted for the measurements units are:

■ DF = 4.6 x (prothrombin time - control time) + bilirubin in mg/dL

■ DF = 4.6 x (prothrombin time - control time) + (bilirubin in μmol/L)/17.1

Once all data is filled in, the calculator will provide the result as a numeric score which is further on to be interpreted by the clinician. In the generic guidelines of the Maddrey score, results above 32 are suggestive for a poor prognosis with 35-45% mortality risk within first month and demand a liver biopsy while they indicate potential need for corticosteroid therapy as a treatment in patients with severe acute alcohol related hepatitis.

To begin with, the discriminant function was used just to predict prognosis and mortality within 30 days and following studies also attributed value in the management of the hepatitis as well, as an indicator for the clinician to start or not corticosteroid therapy.

The only criticism given to the model relates to the usage of the variables for mortality risk stratification but being able to account for in time progression thus cannot really be used for proper monitoring.

Alcoholic hepatitis and cirrhosis

Alcoholic cirrhosis patients also have superimposed alcoholic hepatitis compensated or not and usually score high in most severity indexes, even in the model of end stage liver disease. Severe cases are definitely an indication for corticosteroids that are demonstrated to improve short term survival in the patients.

Excessive alcoholism leads to several hepatic symptoms and affect the liver function to different degrees. Liver conditions caused by prolonged heavy alcohol intake include:

- alcoholic fatty liver disease;

- steatohepatitis;

- alcoholic hepatitis;

- cirrhosis.

Heavy alcohol intake definition is still arguable, with some sources stating it at daily ingestion of more than 10 – 20g for women and 20 – 40g for men.

Alcoholic hepatitis however is a condition that can be treated successfully with medication such as prednisolone but only following discontinuation of alcohol and monitoring of the patient through assessments such as the CIWA-Ar alcohol withdrawal questionnaire.

If left untreated, mortality rates can be significant, even the short term ones ranging from 25 to 45% in patients with the severe condition while in patients with mild to moderate alcoholic hepatitis, mortality risk rates are around 10% in the following three months.

References

1) Maddrey WC, Boitnott JK, Bedine MS, Weber FL Jr, Mezey E, White RI Jr. (1978) Corticosteroid therapy of alcoholic hepatitis. Gastroenterology; 75(2):193-9.

2) Soultati AS, Dourakis SP, Alexopoulou A, Deutsch M, Vasilieva L, Archimandritis AJ. (2006) Predicting utility of a model for end stage liver disease in alcoholic liver disease. World J Gastroenterol; 12(25):4020-5.

3) Kadian M, Kakkar R, Dhar M, Kaushik RM. (2014) Model for end-stage liver disease score versus Maddrey discriminant function score in assessing short-term outcome in alcoholic hepatitis. J Gastroenterol Hepatol; 29(3):581-8.

4) Monsanto P, Almeida N, Lrias C, Pina JE, Sofia C. (2013) Evaluation of MELD score and Maddrey discriminant function for mortality prediction in patients with alcoholic hepatitis. Hepatogastroenterology; 60(125):1089-94.