Real‐World Distribution and Mortality Assessment of MDF and MELD Scores in Hospitalized Patients With Alcohol‐Associated Cirrhosis and Clinically Diagnosed Alcohol‐Associated Hepatitis

Aims The Maddrey Discriminant Function (MDF) and Model for End‐Stage Liver Disease (MELD) scores are widely used to evaluate disease severity and prognosis in patients with alcohol‐associated hepatitis (AH). This study aimed to compare severity classification derived from MDF, MELD, and etiology‐adjusted MELD (MELD[A]), as well as their associations with mortality in hospitalized patients with alcohol‐associated cirrhosis and clinically diagnosed AH. Methods This single‐center retrospective study included 92 hospitalized patients with alcohol‐associated cirrhosis who met the National Institute on Alcohol Abuse and Alcoholism (NIAAA) clinical criteria for AH between April 2015 and April 2023. Severity was classified using MDF, MELD, and MELD(A) scores, and agreement in category assignment was evaluated using weighted kappa statistics. Meanwhile, their associations with 1‐, 3‐, and 12‐month mortality were evaluated using survival analysis and receiver operating characteristic curve analysis. Results MDF and MELD showed limited agreement in severity classification ( κ = 0.37, 95% CI: 0.28–0.47, p < 0.001). MDF classified 44 patients (47.8%) as mild, 17 (18.5%) as moderate, and 31 (33.7%) as severe, whereas MELD classified 0, 59 (64.1%), and 33 (35.9%) patients into these categories, respectively. The etiology‐adjusted MELD(A) score showed higher agreement with MDF than MELD ( κ = 0.54, 95% CI: 0.42–0.66, p < 0.001), and produced substantial redistribution of patient severity categories, although this greater agreement should not be interpreted as evidence of superior prognostic performance. Among the 86 patients with available follow‐up, mortality rates at 1, 3, and 12 months were 5.8%, 10.5%, and 18.6%, respectively. Kaplan–Meier analyses demonstrated statistically significant differences in survival across severity categories defined by MDF, MELD, and MELD(A). Mortality events occurred even in patients classified as having mild or moderate disease by these conventional severity stratifications. Conclusions MDF and MELD provide different perspectives on AH severity because of their distinct weighting of bilirubin, coagulation, and renal function. Their discordant classification and mortality events among lower‐severity categories highlight the heterogeneity of AH and suggest that severity assessment should not rely solely on a single scoring system. These findings should be interpreted with caution given the single‐center retrospective design and limited number of mortality events.