Treatment of Alcoholic Hepatitis with Maddrey Discriminant Function ≥32 or MELD Score >20

Patients with alcoholic hepatitis who reach a Maddrey discriminant function (MDF) of 32 or higher, or a Model for End-stage Liver Disease (MELD) score above 20, carry significant short-term mortality risk. In the absence of contraindications to corticosteroid therapy, this severity threshold identifies those most likely to benefit from prompt, targeted intervention.

Clinical scenario: Severe alcoholic hepatitis confirmed by MDF ≥32 or MELD >20, with no contraindications to corticosteroids. Both scoring systems serve as evidence-based triggers to assess whether active pharmacological treatment should be initiated.

For eligible patients meeting these severity criteria, the recommended first-line approach involves oral corticosteroid therapy. An intravenous adjunct may also be considered alongside it to further improve short-term outcomes. The complete regimen, eligibility criteria, and sequencing are available in the full protocol.

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References

DOI: 10.1002/hep.30866

The MDF (≥32) should be used to assess the need for treatment with corticosteroids or other medical therapies.

A MELD score greater than 20 also should prompt consideration of steroid treatment.

Prednisolone (40 mg/day) given orally should be considered to improve 28-day mortality in patients with severe AH (MDF ≥32) without contraindications to the use of corticosteroids (Fig. 3).

The addition of intravenous NAC to prednisolone (40 mg/day) may improve the 30-day survival of patients with severe AH.

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