Maddrey's Discriminant Function
Quantifies severity of alcoholic hepatitis and identifies patients who may benefit from corticosteroid therapy
Also written as: Maddrey's DF, Maddrey DF, mDF, Maddrey discriminant function, Maddrey score, Maddrey's score, discriminant function.
- Highest activation tier
- Mandatory
- How it is scored
- Scored in code; a detected disagreeing draft value is flagged for correction
- Care settings
- ICU, Inpatient
When it activates
Scribeable activates a calculator from the encounter. The Maddrey's Discriminant Function can activate when the transcript or pasted chart context documents any of these:
- Alcoholic hepatitis severity assessment
- Corticosteroid therapy decision in alcoholic hepatitis
- Acute alcoholic liver injury
A coded diagnosis can also activate it. ICD-10 prefixes carried by the registry: K70, K70.1, K70.4.
Note-type scope: it activates on notes whose subject resolves to hepatology, gi, hospital medicine, critical care. A note that resolves to another subject does not carry it even when the clinician's specialty matches; a note with no resolvable subject (a generic consultation) falls back to the specialty match.
Inputs the note needs
3 inputs. Each is resolved from the transcript, the pasted chart context and charted labs; an input marked "asks you" is requested as a clarification when it is undocumented.
| Input | Type | Unit / options | Guidance |
|---|---|---|---|
| Patient PT (seconds) | lab | s | Patient's prothrombin time in seconds (not INR or prolongation). Asked as: “What is the patient's prothrombin time (PT) in seconds?” |
| Laboratory PT control (seconds) | lab | s | The lab's PT control/reference value in seconds, printed beside the patient PT on the coagulation report — not the INR. Maddrey needs it because the score is 4.6 x (patient PT - control) + bilirubin. |
| Total bilirubin (mg/dL) | lab | mg/dL | Total serum bilirubin in mg/dL, NOT µmol/L. A value of 50 or above cannot be told apart from µmol/L and is refused here; if the patient is that jaundiced, compute the score by hand. GAHS bands at 7.3 and 14.6. Asked as: “What is the total bilirubin (mg/dL)?” |
Scoring
mDF = 4.6 x (PT patient - PT control) + total bilirubin (mg/dL)
4.6 × (Patient PT (seconds) − Laboratory PT control (seconds)) + Total bilirubin (mg/dL)
Interpretation
<32: Mild alcoholic hepatitis, steroids not indicated, supportive care. >=32: Severe alcoholic hepatitis with ~50% 30-day mortality — consider prednisolone 40 mg/day x 28 days if no contraindications (active infection, GI bleed, renal failure, pancreatitis). Reassess response at day 7 with Lille score.
Evidence
Sources carried in Scribeable's citation registry for this calculator; guideline version: Maddrey WC et al. 1978; AASLD 2019.
- Maddrey WC et al. Corticosteroid therapy of alcoholic hepatitis (Maddrey's Discriminant Function)Maddrey et al. (mDF) 1978 · 1978 · AASLD · link last verified 2026-04-14
How Scribeable handles it in the note
When an encounter activates the Maddrey's Discriminant Function at the mandatory tier, Scribeable resolves its inputs from the transcript, the pasted chart context and any charted labs, and asks you for a missing input you can supply before the note is finalised. Bedside-exam and separately ordered study values are not requested one input at a time; a calculator that carries a combined clarification question may still put that single question to you.
The score is computed in code from the resolved inputs, not recalled by the language model. If the draft states a Maddrey's Discriminant Function value that disagrees with the computed one, the disagreement is flagged to the second drafting pass, which is instructed to correct the score and its interpretation before you see the note.
Classified as a risk score: activated strictly, by a documented trigger, never by a permissive reading of the encounter.
See it activate on your own encounter
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