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Korean J Med > Volume 81(3); 2011 > Article |
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Parameter/Discriminator | Score | Parameter/Discriminator | Score |
---|---|---|---|
Female sex | +2 | Drug history | |
ALP:AST (or ALT) ratio | Positive | -4 | |
< 1.5 | +2 | Negative | +1 |
1.5-3.0 | 0 | Average alcohol intake | |
> 3.0 | -2 | < 25 g/day | +2 |
Serum globulins or IgG above normal | > 60 g/day | -2 | |
> 2.0 | +3 | Liver histology | |
1.5-2.0 | +2 | Interface hepatitis | +3 |
1.0-1.5 | +1 | Predominantly lymphoplasmacytic infiltrate | +2 |
< 1.0 | 0 | Rosetting of liver cells | +1 |
ANA, SMA, or LKM-1 | None of the above | -5 | |
> 1:80 | +3 | Biliary changesa | +3 |
1:80 | +2 | Atypical featuresb | -3 |
1:40 | +1 | Other autoimmune disease in patient or first-degree relative | +2 |
< 1:40 | 0 | Optional additional parameters | |
AMA-positive | -4 | Seropositivity for other defined antibodies | +2 |
Hepatitis viral markers | HLA DR3 or DR4 | +1 | |
Positive | -3 | Response to therapy | |
Negative | +3 | Remission alone | +2 |
Remission with relapse | +3 | ||
Interpretation of aggregate scores |
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Pretreatment: | Post-treatment: | ||
Definite AIH | > 15 | Definite AIH | > 17 |
Probable AIH | 10-15 | Probable AIH | 12-17 |
AIH, autoimmune hepatitis; ALP, alkaline phosphatase; AST, alanine aminotransferase; ALT, aspartate aminotransferase; IgG, immuno- globulin G; ANA, anti-nuclear antibody; SMA, anti-smooth muscle antibody; LKM, anti-liver-kidney microsome antibody; AMA, anti- mitochondrial antibody; HLA, human leukocyte antigen.
Variable | Cutoff | Points |
---|---|---|
ANA or SMA | 1:40 | 1 |
ANA or SMA | 1:80 | |
or LKM | 1:40 | 2 |
or SLA | Positive | |
IgG | Upper normal limit | 1 |
> 1.10 times normal limit | 2 | |
Liver histologya | Compatible with AIH | 1 |
Typical AIH | 2 | |
Absence of viral hepatitis | Yes | 2 |
Definite H: ≥ 7 Probable AIH: ≥ 6 |
ANA, anti-nuclear antibody; SMA, anti-smooth muscle antibody; LKM, anti-liver-kidney microsome antibody; SLA, anti-soluble liver antigen antibody; IgG, immunoglobulin G; AIH, autoimmune hepatitis.
AIH (n =22) | Toxic (n =50) | NAFLD (n =18) | PBC (n =11) | PBC/AIH (n =5) | p value | |
---|---|---|---|---|---|---|
Age (years) | 45.8 (28-66) | 46.5 (18-73) | 41.8 (19-69) | 49.9 (38-69) | 51.2 (34-63) | 0.059 |
M:F | 1:21 | 18:32 | 10:8 | 1:10 | 0:5 | 0.01 |
AST (IU/L) | 366 (16-1560) | 580 (24-2057) | 94.5 (35-200) | 87 (26-189) | 121 (50-237) | <0.01 |
ALT (IU/L) | 428 (11-2480) | 858 (11-2936) | 152 (39-458) | 88 (12-218) | 190 (42-561) | <0.01 |
ALP/AST ratio | 1.0 (0.1-5.6) | 0.77 (0.05-5.6) | 1.1 (0.34-3.4) | 3.8 (0.9-8.5) | 3.4 (0.3-5.3) | <0.01 |
IgG (mg/dL) | 2478 (783-5189) | 1289 (678-2082) | 1322 (809-1844) | 1609 (21-2768) | 1736 (1066-2536) | <0.01 |
Autoantibodiesa (n [%]) | 19 (90.5%) | 15 (30%) | 7 (36.8%) | 8 (72.7%) | 5 (100%) | <0.01 |
Typical or compatible histologyb | 21 (95.5%) | 1 (2.0%) | 0 | 3 (27.3%) | 5 (100%) | <0.01 |
Original revisedc | 17.1 (11-25) | -3.5 (-9-0) | 1.4 (-2-4) | -5.5 (-4-6) | 7.8 (4-10) | <0.01 |
Simplifiedd | 6.8 (4-8) | 2.5 (2-5) | 2.6 (2-5) | 4.5 (2-8) | 6.6 (6-8) | <0.01 |
AIH, autoimmune hepatitis; NAFLD, nonalcoholic fatty liver disease; PBC, primary biliary cirrhosis; ALP, alkaline phosphatase; AST, alanine aminotransferase; ALT, aspartate aminotransferase; IgG, immunoglobulin G.
Diagnosis by scoring system, n (%) |
||||||
---|---|---|---|---|---|---|
Originala |
Simplifiedb |
Original |
Simplified |
Original |
Simplified |
|
Definite | Probable | Non-diagnostic | ||||
AIH [22] | 14 (63.6%) | 17 (77.3%) | 8 (36.4%) | 3 (13.6%) | 0 | 2 (9.1%) |
Toxic hepatitis [50] | 0 | 0 | 0 | 0 | 50 (100%) | 50 (100%) |
NAFLD [18] | 0 | 0 | 0 | 0 | 18 (100%) | 18 (100%) |
PBC [11] | 0 | 1 (9.1%) | 0 | 2 (18.2%) | 11 (100%) | 8 (72.7%) |
PBC/AIH [5] | 0 | 2 (40%) | 0 | 3 (60%) | 5 (100%) | 0 |
Simplified scoring criteria | Sensitivity | Specificity |
---|---|---|
Definite (≥ 7) | 77.3% | 98.7% |
Overall (≥ 6) | 90.9% | 96.2% |
Down-graded (n =4) | Up-graded (n =5) | p value | |
---|---|---|---|
M:F | 0:5 | 0:4 | 1.000 |
ALP (IU/L) | 148.0 | 0:4 | 0.142 |
ALP/AST ratio | 2.6 | 1.8 | 0.327 |
ANA or SMA ≥ 1:80 (n [%]) | 2 (50%) | 5 (100%) | 0.167 |
AMA positive (n [%]) | 0 | 0 | 1.000 |
IgG > 1.1 × NL (n [%]) | 1 (25%) | 3 (60%) | 0.524 |
Florid bile duct lesions | 2 (50%) | 1 (20%) | 0.524 |
Compatible or typical histology with AIHa | 3 (75%) | 5 (100%) | 0.264 |
Original revisedb | 15.3 | 16.0 | 0.805 |
p values were determined by Fisher’s exact test except for ALP, ALP/AST ratio, and original revised scoring criteria.
ALP, alkaline phosphatase; AST, alanine aminotransferase; ALT, aspartate aminotransferase; ANA, anti-nuclear antibody; SMA, anti-smooth muscle antibody; AMA, anti-mitochondrial antibody; IgG, immunoglobulin G; NL, normal limit; AIH, autoimmune hepatitis.
True-negative (n = 8) | False-positive (n = 3) | p value | |
---|---|---|---|
M:F | 0:8 | 1:2 | 0.273 |
ALP (IU/L) | 243.8 (128-492) | 310.7 (173-441) | 0.540 |
AST | 78 (26-139) | 68 (61-189) | 0.683 |
ALT | 91 (12-218) | 80 (46-125) | 0.838 |
ALP/AST ratio | 4.0 | 3.2 | 0.414 |
Exclusion of viral hepatitis | 9 (100) | 3 (100) | 1.000 |
ANA or SMA ≥1:80 (n [%]) | 5 (62.5) | 3 (100) | 0.491 |
AMA positive (n [%]) | 7 (87.5) | 2 (66.7) | 0.491 |
IgG > 1.1 × NL (n [%]) | 0 | 3 (100) | 0.006 |
Florid bile duct lesions | 7 (87.5) | 3 (100) | 0.727 |
Compatible or typical histology with AIHa | 2 (25) | 1 (33.3) | 1.000 |
Original revisedb | -1.8 | 3.0 | 0.018 |
p values were determined by Fisher’s exact test except for ALP, AST, ALT, ALP/AST ratio, and original revised scoring criteria.
p values were determined by the Kruskal-Wallis test for ALP, AST, ALT, ALP/AST ratio, and original revised scoring criteria.
ALP, alkaline phosphatase; AST, alanine aminotransferase; ALT, aspartate aminotransferase; ANA, anti-nuclear antibody; SMA, anti-smooth muscle antibody; AMA, anti-mitochondrial antibody; IgG, immunoglobulin G; NL, normal limit; AIH, autoimmune hepatitis.
Pure AIH (n = 22) | AIH/PBC (n = 5) | p value | |
---|---|---|---|
Age (yr) | 46 | 51 | 0.521 |
ALP (IU/L) | 120 (54-246) | 237 (68-485) | 0.046 |
AST (IU/L) | 366 (16-1520) | 121 (50-237) | 0.190 |
ALT (IU/L) | 428 (11-2480) | 190 (42-561) | 1.000 |
Bilirubin (mg/dL) | 5.2 (0.3-16.9) | 0.8 (0.4-1.1) | 0.092 |
INR | 1.2 (0.9-2.0) | 1.0 (0.9-.1.) | 0.034 |
ALP/AST ratio | 1.0 (0.1-5.6) | 3.4 (0.3-5.3) | 0.039 |
IgG (mg/dL) | 2478 (783-5189) | 1736 (1066-2536) | 0.236 |
IgG > 1.1 × NL (n [%]) | 13 (59.1%) | 2 (40%) | 0.628 |
ANA or SMA ≥ 1:80 | 18 (81.8%) | 5 (100%) | 0.561 |
AMA | 0 | 4 (80.0%) | <0.001 |
Compatible or typical histology with AIHa | 21 (95.5%) | 5 (100%) | 1.000 |
Biliary changes (n [%]) | 7 (25.9%) | 5 (100%) | 0.010 |
Original revisedb score | 17.1 (11-25) | 7.8 (4-10) | 0.001 |
Simplifiedc score | 6.8 (4-8) | 6.6 (6-8) | 0.594 |
p values were determined by the Kruskal-Wallis test for age, ALP, AST, ALT, bilirubin, INR, ALP/AST ratio, IgG, original revised score, and simplified score.
p values were determined by the Pearson chi-square test except for age, ALP, AST, ALT, bilirubin, INR, ALP/AST ratio, IgG, original re- vised score, and simplified score.
AIH, autoimmune hepatitis; PBC, primary biliary cirrhosis; ALP, alkaline phosphatase; AST, alanine aminotransferase; ALT, aspartate aminotransferase; IgG, immunoglobulin G; ANA, anti-nuclear antibody; SMA, anti-smooth muscle antibody; AMA, anti-mitochondrial antibody; NL, normal limit.
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