Understanding the Maddrey Score

Imagine you’re sitting in the doctor’s office after deciding to take charge of your liver health. You’re determined, hopeful, and ready for the changes ahead, but then your doctor mentions something about the “Maddrey score.” Suddenly, you find yourself confused, a little anxious, and unsure what this number means for your future and your path to better health.

While the Maddrey score can seem intimidating, it actually provides valuable insight into our liver health. It’s a helpful guide in determining the appropriate treatment and lifestyle changes we should make to improve our liver health. Let’s unpack what the Maddrey score is and how to calculate it to help start our journey to healing our liver.

What Is the Maddrey Score?

The Maddrey score or Maddrey discriminant function is a tool used to determine the severity of alcoholic hepatitis (a form of alcohol-related liver disease). It uses scores from different blood tests, which gives us insight into the functioning of our liver. Think of it as a report card for our liver health. 

Our doctor uses the Maddrey score to get a better idea of the outlook of our condition and help develop an appropriate treatment plan. This insight is particularly important to help us navigate the complexities of alcoholic hepatitis and work towards achieving a better prognosis. (To learn whether your current drinking habits are causing liver damage and warrant Maddrey score evaluation, check out “How Much Alcohol Causes Liver Damage?”) 

Now that we’re familiar with the Maddrey score’s role in assessing our liver health, let’s dive deeper into the specifics of alcoholic hepatitis and how it impacts our liver.

The Basics of Alcoholic Hepatitis

Alcoholic hepatitis is acute liver inflammation due to excessive alcohol consumption. Since our liver is in charge of breaking down the toxins in alcohol, too much alcohol overloads the liver and damages the tissues. 

Over time, inflammation can lead to liver scarring and cirrhosis (permanent scarring that impairs liver function). Alcoholic hepatitis can range from mild to severe and symptoms include fatigue, weight loss, changes in appetite, pain or swelling in the abdomen, and jaundice. The condition is associated with a high mortality rate, and treatment usually depends on the severity of the condition. This is where the Maddrey score comes in handy.

Components of the Maddrey Discriminant Function (MDF) Score

The MDF score is made up of two main components. The first is how long it takes for our blood to clot (prothrombin time). Prothrombin is a protein made by the liver that helps our blood clot. A high prothrombin time means it takes longer for our blood to clot, which happens when our liver isn’t producing an adequate amount of blood-clotting proteins. 

The second part of the MDF score is our serum bilirubin level. Bilirubin is a substance our body produces to break down old red blood cells. A healthy liver is able to get rid of bilirubin, but for those with liver problems, bilirubin can build up to abnormal levels, leading to symptoms such as dark-colored urine and yellowing of the skin and eyes (jaundice).

We can calculate our Maddrey score using the discrimination function:

Bilirubin (mg/dL) + 4.6 x (prothrombin time - control time)

Or, there are also online Maddrey score calculators that do the work for us (assuming we have all the data from a doctor after having our tests done — don’t try to test your own blood at home!). Now that we’ve figured out our Maddrey score, what does it mean? 

Reading the Maddrey Score

If our Maddrey score is less than 32, we have mild to moderate hepatitis. While it’s named “mild to moderate,” alcoholic hepatitis is a serious condition even at a less severe level. A study found that moderate alcoholic hepatitis has a 6% mortality rate at 28 days and 13% at the one-year mark. While mild to moderate alcoholic hepatitis is miles more favorable than its severe form, it should be taken seriously. 

If our Maddrey score is over 32, this means that we have severe alcoholic hepatitis. Severe alcohol hepatitis means that the damage to our liver can quickly lead to permanent liver damage and failure that can be life-threatening. Severe alcoholic hepatitis has a 6-month mortality rate of about 40% after the onset of the condition. However, aggressive management of the condition and younger age may improve our outlook. 

So, although the Maddrey score is just a number, it helps us get a clearer picture of the severity of liver damage from alcohol and guides us toward the best treatment options to improve our liver health.

Treating Alcoholic Hepatitis: Application of the Maddrey Score

The type of treatment depends on individual factors, but more so on the severity of the condition. For mild to moderate alcoholic hepatitis, liver damage can often be reversed, and treatment includes more lifestyle changes. 

• Nutritional support. Malnutrition is common with alcoholic hepatitis due to impaired nutrient absorption, and is also associated with increased mortality rate. Nutritional support for those with alcohol hepatitis typically includes consuming 1.5 grams of protein per kg of body weight and around 30-40 calories per kg of body weight per day. Supplementation of micronutrients such as zinc, folate, thiamine, pyridoxine, and vitamins B, A, D, and E help replenish deficiencies caused by alcohol. 
• Abstinence from alcohol. Avoiding alcohol is crucial in preventing further damage to our liver. Abstinence also gives the liver a break and a chance to heal. To get a better idea of how long this may take, check out “How Long Does It Take for the Liver to Heal From Alcohol Misuse?”.
• Supportive treatments. Heavy drinking is associated with many health issues that can impact our liver health. Supportive treatments for conditions such as diabetes, obesity, and other complications may also be treated. 

The Maddrey score is especially helpful in determining whether extensive treatment is needed. Severe alcoholic hepatitis is frequently treated with medications that reduce inflammation and immune system activity (corticosteroids) or medications used to increase blood flow through the blood vessels (pentoxifylline). While corticosteroids can help treat severe liver damage, they can be unsafe for people in the following categories or with the following conditions:

• Are over 50 years old 
• Have uncontrolled diabetes
• Have previous kidney injury
• Have persistent high levels of bilirubin
• Choose to continue to drink alcohol 
• Experience upper GI bleeding
• Have pancreatitis
• Have signs of hepatic encephalopathy (loss of brain function from damaged liver)

Your doctor will utilize the Maddrey score as well as other individual factors to decide if corticosteroid therapy is the best plan of action. Along with pharmacological treatments, quitting alcohol is critical to ensuring severe alcoholic hepatitis doesn’t progress, and to increase our chances of survival. Doctors may also order other tests to better distinguish between different liver disorders and to get a clearer picture of our liver function and health.

Other Tests for Liver Function

While the Maddrey score is a great diagnostic and prognostic tool for alcoholic hepatitis, other liver function tests give us a clearer picture of our liver health and further guide our plan of treatment. The more we know, the more informed the choices we can make! Liver function panels usually include a range of tests: 

• Mitochondrial antibodies test. This test looks for antibodies that are commonly produced if we have primary biliary cirrhosis (bile buildup that leads to liver scarring), chronic active hepatitis, and other autoimmune disorders. 
• Alanine transaminase (ALT) test. This enzyme is found predominantly in the liver and is released into the bloodstream after acute liver damage. If ALT is high, it’s a good indicator of liver damage.
• Aspartate transaminase (AST) test. AST is an enzyme that exists in our liver. When liver cells are damaged, AST can leak into our bloodstream, causing abnormally high levels. With other tests, AST can be an indicator of liver damage and other health issues.
• Gamma-glutamyl transpeptidase (GGT) test. GGT is often administered with other tests to distinguish between liver and bone disease. Since ALT can be elevated due to bone disease, GGT can be an illuminating factor. The enzyme is usually elevated when there’s an obstruction to our bile ducts that carry bile from the liver to our intestines. 
• Lactic dehydrogenase (LDH) test. LDH is a type of protein that’s released when our tissues are damaged. There are five types of LDH enzymes known as isoenzymes. LDH-5 is the isoenzyme found mainly in our liver and skeletal muscle, helping us specifically detect liver damage.

After using the Maddrey score and other liver function tests, our doctor may recommend pharmacological treatments, nutritional support, and the cornerstone of alcoholic hepatitis treatment — lifestyle changes to improve our liver health and function.

Beyond Maddrey’s Discriminant Function: Maintaining a Healthy Liver 

As we’ve learned, alcoholic hepatitis is a serious condition that can be life-threatening. Taking these steps to maintain a healthy liver can reduce the risk of alcoholic hepatitis or reverse liver damage: 

• Look out for signs of liver dysfunction. Signs of liver dysfunction including pain, jaundice, fatigue, and unexplained weight loss are not always apparent in the early stages. However, alcohol withdrawal symptoms are common in those of us with alcoholic hepatitis and can be a warning sign to check liver function even if no other signs are present. 
• Take liver function tests. Signs of liver dysfunction aren’t always apparent until the later stages. If we’re concerned about our liver health, we can talk to our doctor about regular liver function tests, and there are even options to take liver function tests at home.
• Avoid toxic substances. Our liver is in charge of getting rid of toxic substances in our body. Avoid toxic substances such as alcohol, medications, and other drugs. 
• Maintain a healthy diet. Eating a balanced liver-healthy diet low in processed foods and added sugars helps us maintain a healthy weight and prevent excess fat buildup in our liver. On top of that, give your liver another health boost by trying liver detox drinks.
• Get adequate exercise. Staying active improves blood flow to the liver, decreases inflammation, and prevents excess fat buildup which can impair normal liver functioning. 
• Seek support. Quitting or cutting back on alcohol is crucial in preventing alcoholic hepatitis and maintaining a healthy liver, but it's not always easy. We can explore different treatment options to help us through the journey and regain control of our liver health and relationship with alcohol. 

These strategies not only help us prevent alcoholic hepatitis by maintaining a healthy liver, but also help us take intentional steps to improve our liver health after our Maddrey score raises a red flag. 

A Clearer Picture

The Maddrey score is just a number, but this number is critical in helping us understand how much liver damage we have from alcohol. It not only helps our doctor determine the best treatment options for us but also gives us an idea of what our outlook may be. Alcoholic hepatitis is a severe form of alcohol-related liver disease that can be life-threatening. While alcoholic hepatitis can be treated to a certain extent, the most effective way to prevent and stop liver damage is to quit alcohol, a substance that is undoubtedly toxic to our liver.