Question 1

Should I use the MDF or the newer scores like GAHS?

Accepted Answer

Use both. The MDF identifies the highest-risk patients (DF ≥ 32) who are candidates for steroids. The GAHS provides better discrimination in the intermediate-risk range. Many centres calculate MDF at admission to screen for severe alcoholic hepatitis and calculate GAHS for further risk stratification.

Question 2

Can I use the MDF in acute liver failure from other causes?

Accepted Answer

No — the MDF was specifically derived for alcoholic hepatitis. In acute liver failure from paracetamol overdose, viral hepatitis, or other causes, use the King's College Criteria or the Clichy criteria for prognostic assessment and transplant decision-making.

Question 3

What if my lab uses INR instead of PT?

Accepted Answer

The original formula was developed with PT in seconds. INR can be used if your lab does not report PT, but this version has not been as rigorously validated. If using PT, make sure to use the same laboratory's control PT for consistent results across serial measurements.

Question 4

How quickly should I reassess the DF?

Accepted Answer

The DF is typically calculated at admission to guide the initial decision about steroids. The Lille score (calculated on day 7 of therapy) then provides a dynamic assessment of response. Serial DF measurements during therapy are not standard practice.