Understanding Your Maddrey Score: A Guide to Liver Health

Imagine sitting in your doctor's office after deciding to take control of your liver health. You feel determined and hopeful about the changes ahead, but then your doctor mentions the "Maddrey score." Suddenly, you're confused, anxious, and unsure what this number means for your future and your path to better health.

While the Maddrey score might seem intimidating, it actually provides valuable insight into your liver health. It's a helpful guide in determining the right treatment and lifestyle changes needed to improve your liver function. Let's explore what the Maddrey score is and how it's calculated to help you start your journey toward liver healing.

What Is the Maddrey Score?

The Maddrey score, or Maddrey discriminant function, is a tool used to assess the severity of alcoholic hepatitis—a form of alcohol-related liver disease. It uses results from blood tests to evaluate how well your liver is functioning. Think of it as a report card for your liver health.

Your doctor uses the Maddrey score to better understand your condition's outlook and develop an appropriate treatment plan. This insight is particularly important for navigating alcoholic hepatitis and working toward a better prognosis.

The Basics of Alcoholic Hepatitis

Alcoholic hepatitis is acute liver inflammation caused by excessive alcohol consumption. Your liver is responsible for breaking down alcohol toxins, but too much alcohol overloads the organ and damages its tissues.

Over time, inflammation can lead to liver scarring and cirrhosis—permanent scarring that impairs liver function. Alcoholic hepatitis ranges from mild to severe, with symptoms including:

• Fatigue
• Weight loss
• Changes in appetite
• Abdominal pain or swelling
• Jaundice (yellowing of skin and eyes)

The condition is associated with a high mortality rate, and treatment depends on its severity—this is where the Maddrey score becomes essential.

Components of the Maddrey Score

The Maddrey score consists of two main components:

• Prothrombin time: Measures how long your blood takes to clot. Prothrombin is a liver-produced protein that helps blood clot. A high prothrombin time indicates your liver isn't making enough blood-clotting proteins.
• Serum bilirubin level: Bilirubin is a substance your body produces when breaking down old red blood cells. A healthy liver removes bilirubin, but with liver problems, it can build up, causing symptoms like dark urine and jaundice.

You can calculate your Maddrey score using this formula:

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

Alternatively, online Maddrey score calculators can do the work for you—assuming you have test results from your doctor. Don't attempt to test your own blood at home!

Reading the Maddrey Score

Score less than 32: Indicates mild to moderate hepatitis. While called "mild to moderate," alcoholic hepatitis remains serious even at this level. Studies show moderate alcoholic hepatitis has a 6% mortality rate at 28 days and 13% at one year.

Score over 32: Indicates severe alcoholic hepatitis. This means liver damage can quickly lead to permanent damage and liver failure, which can be life-threatening. Severe alcoholic hepatitis has approximately a 40% six-month mortality rate after onset, though aggressive treatment and younger age may improve outlook.

Although just a number, the Maddrey score helps clarify the severity of alcohol-related liver damage and guides you toward the best treatment options.

Treating Alcoholic Hepatitis: Using the Maddrey Score

Treatment depends on individual factors, but particularly on condition severity:

For mild to moderate alcoholic hepatitis: Liver damage can often be reversed with lifestyle changes:

• Nutritional support: Malnutrition is common with alcoholic hepatitis. Support typically includes 1.5 grams of protein per kg of body weight and 30-40 calories per kg daily. Supplement with micronutrients like zinc, folate, thiamine, and vitamins A, B, D, and E.
• Alcohol abstinence: Avoiding alcohol is crucial to prevent further liver damage and allow healing.
• Supportive treatments: Address related health issues like diabetes, obesity, and other complications.

For severe alcoholic hepatitis: Often treated with medications that reduce inflammation and immune system activity (corticosteroids) or improve blood flow (pentoxifylline). Corticosteroids may be unsafe for people who:

• Are over 50 years old
• Have uncontrolled diabetes
• Have previous kidney injury
• Have persistent high bilirubin levels
• Continue to drink alcohol
• Experience upper GI bleeding
• Have pancreatitis
• Show signs of hepatic encephalopathy

Your doctor will use the Maddrey score and other factors to determine if corticosteroid therapy is appropriate. Along with medications, quitting alcohol is critical to prevent progression and increase survival chances.

Other Tests for Liver Function

While the Maddrey score is valuable for alcoholic hepatitis, other liver function tests provide a clearer picture of your liver health:

• Mitochondrial antibodies test: Detects antibodies associated with primary biliary cirrhosis and autoimmune disorders
• Alanine transaminase (ALT) test: Measures enzyme released after acute liver damage
• Aspartate transaminase (AST) test: Detects enzyme leakage from damaged liver cells
• Gamma-glutamyl transpeptidase (GGT) test: Distinguishes between liver and bone disease
• Lactic dehydrogenase (LDH) test: Identifies tissue damage, particularly liver-specific LDH-5 isoenzyme

Beyond the Maddrey Score: Maintaining a Healthy Liver

Alcoholic hepatitis is serious and potentially life-threatening. These steps can help maintain liver health or reverse damage:

• Watch for liver dysfunction signs: Including pain, jaundice, fatigue, and unexplained weight loss. Alcohol withdrawal symptoms can also indicate liver issues.
• Get regular liver function tests: Since symptoms aren't always apparent early, regular testing helps monitor liver health.
• Avoid toxic substances: Particularly alcohol, certain medications, and other drugs.
• Maintain a healthy diet: Eat balanced, liver-healthy meals low in processed foods and added sugars.
• Exercise regularly: Improves liver blood flow, reduces inflammation, and prevents fat buildup.
• Seek support: Quitting or reducing alcohol is crucial but challenging. Explore treatment options and support resources like Quitemate to help regain control of your liver health and relationship with alcohol.

A Clearer Picture

The Maddrey score is more than just a number—it's critical for understanding alcohol-related liver damage. It helps your doctor determine the best treatment options and gives you insight into your outlook. While alcoholic hepatitis can be treated to some extent, the most effective way to prevent and stop liver damage is to quit alcohol, a substance that's undoubtedly toxic to your liver.