In patients with acute alcoholic hepatitis, how is the Maddrey discriminant function used in deciding on whether or not to administer steroids?

Bottom line: Maddrey discriminant function ≥ 32 identifies patients who will significantly benefit from receiving glucocorticosteroids for short-term improvement in survival.
Summary: Hepatitis discriminant function for corticosteroid therapy in alcoholic hepatitis : 4.6 × (patient’s prothrombin time – control prothrombin time) + total bilirubin (in mg/dL) (DynaMed Plus entry for alcoholic hepatitis)
Systematic review: glucocorticosteroids for alcoholic hepatitis. Aliment Pharmacol Ther 2008 Jun;27(12):1167-1178.
Reviewed RCTs comparing glucocorticosteroids v. placebo or no intervention for patientw with alcoholic hepatitis. RESULTS: Included 15 trials (N=72.). Overall mortality rate was 39.5%. Risk of bias occurred in 12 trials and significant heterogeneity in all analyses. Overall, glucocorticosteroids did not statistically reduce mortality compared with placebo or no intervention (relative risk 0.83, 95% CI 0.63–1.11). Glucocorticosteroids significantly reduced mortality in subgroup of trials for patients with Maddrey’s score ≥ 32 or hepatic encephalopathy (RR 0.37, 95% CI 0.16-0.86).

Mathurin P, et al. Corticosteroids improve short-term survival in patients with severe alcoholic hepatitis (AH): individual data analysis of the last three randomized placebo controlled double blind trials of corticosteroids in severe AH.
J Hepatol. 2002 Apr;36(4):480-7.
Similarly, a reanalysis of  indidvidual patient data from 3 clinical trials (102 patients on placebo; 113 patients on corticosteroids) showed 1-month survival for patients with Maddrey’s ≥32 who were treated with corticosteroids was 85% compared with 65% for those who received placebo (P=0.001).

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About Amy

Clinical Informationist at EUH Branch Library
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