Alcoholic Hepatitis Score Calculator

Calculate Maddrey DF, MELD, ABIC, GAHS, and Lille scores to assess severity and prognosis in alcoholic hepatitis patients.

Medical Disclaimer: This tool is for educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a qualified healthcare provider with any questions regarding a medical condition.

Clinical Assessment: Alcoholic hepatitis (AH) is an acute inflammatory liver injury associated with high short-term mortality. These prognostic scores help identify patients who may benefit from specific treatments like corticosteroids.

Units:
SI Units
US Units
Patient's age in years
Patient's biological sex

Laboratory Values

Prothrombin time in seconds (preferred for Maddrey score)
PT (seconds) is preferred for accurate Maddrey score calculation
Serum total bilirubin concentration
To convert μmol/L to mg/dL: divide by 17.1
Serum creatinine concentration
To convert μmol/L to mg/dL: divide by 88.4
Serum albumin concentration
White blood cell count
Blood urea nitrogen concentration
Lille Score Parameters (Day 0 and Day 7)

Lille score requires laboratory values at Day 0 and after 7 days of treatment to assess corticosteroid response.

Total bilirubin at treatment initiation
Total bilirubin after 7 days of treatment
Serum albumin at treatment initiation
Prothrombin time at treatment initiation
Lille Score Formula:
Lille = 3.19 - (0.101 × Age) + (0.147 × Albumin₀) + (0.0165 × ΔBilirubin) - (0.206 × Renal insufficiency) - (0.0065 × Bilirubin₀) - (0.0096 × PT₀)
Mild Case Example
Moderate Case Example
Severe Case Example
Critical Case Example
Calculating scores...

Understanding Alcoholic Hepatitis Scores

Alcoholic hepatitis is a severe, life-threatening condition that occurs in patients with chronic excessive alcohol consumption. Prognostic scoring systems help clinicians assess disease severity, predict outcomes, and guide treatment decisions.

Clinical Significance:

These scores help identify patients with severe alcoholic hepatitis who may benefit from specific therapies like corticosteroids or pentoxifylline, and those at high risk of short-term mortality who may require more intensive monitoring or consideration for liver transplantation.

Score Definitions and Interpretation

Score Formula Interpretation Clinical Utility
Maddrey DF 4.6 × (PT - control PT) + Bilirubin ≥32: Severe disease, consider corticosteroids Traditional score for identifying severe AH. Requires PT in seconds.
MELD 3.78×ln(Bilirubin) + 11.2×ln(INR) + 9.57×ln(Creatinine) + 6.43 ≥21: Severe disease, consider corticosteroids Widely used, validated for AH prognosis. Creatinine capped at 1.0-4.0 mg/dL.
ABIC Age + (Bilirubin×0.1) + (INR×10) + (Creatinine×0.3) Low (<6.71), Intermediate (6.71-8.99), High (≥9.0) Stratifies 90-day mortality risk
GAHS Age ≥50, WBC ≥15, BUN ≥21, Bilirubin >7.3, INR >1.5 (1 point each) ≥9: Severe disease, consider corticosteroids Alternative to Maddrey DF, good discrimination
Lille Score 3.19 - 0.101×Age + 0.147×Albumin₀ + 0.0165×ΔBilirubin - 0.206×Renal insufficiency - 0.0065×Bilirubin₀ - 0.0096×PT₀ <0.45: Responder to corticosteroids; ≥0.45: Non-responder Predicts response to corticosteroid therapy at day 7. Requires Day 0 and Day 7 values.

Key Formula Corrections

Important Updates in This Calculator:

  • Maddrey DF: Now uses actual PT (seconds) instead of estimated PT from INR. This is more accurate and clinically relevant.
  • Lille Score: Implemented the complete published formula rather than a simplified version.
  • Unit Conversion: Added conversion notes for μmol/L to mg/dL for bilirubin and creatinine.
  • Parameter Requirements: Clearly separated Day 0 and Day 7 values for accurate Lille score calculation.

Treatment Guidelines Based on Scores

1

Maddrey DF ≥32 or MELD ≥21: Consider prednisolone 40mg daily for 28 days (with or without a 2-week taper) after ruling out infections and other contraindications.

2

Lille Score ≥0.45 at Day 7: Consider discontinuing corticosteroids due to poor response and reassess treatment strategy.

3

Nutritional Support: All patients with alcoholic hepatitis require aggressive nutritional support (35-40 kcal/kg/day and 1.2-1.5 g protein/kg/day).

4

Alcohol Cessation: Absolute abstinence is critical. Referral to addiction specialists and consideration of pharmacotherapy (e.g., baclofen) may be appropriate.

Mortality Risk Stratification

  • Low Risk: 30-day mortality <10%
  • Intermediate Risk: 30-day mortality 10-30%
  • High Risk: 30-day mortality 30-50%
  • Critical Risk: 30-day mortality >50%

Calculator Features:

  • Calculates five major prognostic scores for alcoholic hepatitis with corrected formulas
  • Uses actual PT (seconds) for accurate Maddrey score calculation
  • Implements complete Lille formula with Day 0 and Day 7 parameters
  • Provides color-coded risk stratification for each score
  • Generates treatment recommendations based on calculated scores
  • Estimates 30-day, 90-day, and 180-day mortality risks
  • Visualizes scores with interactive charts

Frequently Asked Questions

The original Maddrey Discriminant Function formula uses prothrombin time in seconds. While INR can be converted to PT, this conversion introduces error because control PT values vary between laboratories. For accurate Maddrey score calculation, actual PT in seconds is preferred. This calculator allows both inputs but prioritizes PT for Maddrey calculation.

The control PT value (normal PT) is typically 12-13 seconds, but varies by laboratory. The original Maddrey studies used laboratory-specific control values. This calculator uses a standard control PT of 12.0 seconds, but for maximum accuracy, you should use your laboratory's specific control PT value in the formula: Maddrey DF = 4.6 × (Patient's PT - Laboratory's Control PT) + Bilirubin.

This calculator implements the complete Lille score formula as published by Louvet et al. in Hepatology (2007). It requires Day 0 (baseline) and Day 7 values after starting corticosteroids. The formula is: Lille = 3.19 - 0.101 × Age + 0.147 × Albumin₀ + 0.0165 × ΔBilirubin - 0.206 × Renal insufficiency - 0.0065 × Bilirubin₀ - 0.0096 × PT₀, where renal insufficiency is defined as creatinine >1.3 mg/dL.

You can use the INR input option. The calculator will estimate PT from INR using the formula: PT = INR × 12.5 (assuming control PT of 12.5 seconds). However, this is less accurate than using actual PT in seconds. For clinical decision making, especially when Maddrey score is near the 32 cutoff, actual PT measurement is strongly recommended.

No, these scores are specifically validated for alcoholic hepatitis. Non-alcoholic steatohepatitis (NASH) has different pathophysiology and prognostic factors. The MELD score may have some utility in advanced NASH, but the Maddrey, ABIC, GAHS, and Lille scores are not validated for NASH. Separate scoring systems exist for NASH and other liver diseases.

Important Notes:

  • These scores should be used as part of a comprehensive clinical assessment, not in isolation
  • All scores have limitations and should be interpreted in the clinical context
  • Early reassessment and response evaluation are critical in managing alcoholic hepatitis
  • This calculator uses standard formulas but may not reflect individual institutional protocols
  • For accurate Maddrey score calculation, use actual PT in seconds rather than INR