Pathology Associates Of Lexington, P.A.

Calculating Whether Hepatitis is AIH:

Think about AIH any time you see portal plasma cells and eosinophiles.¹ The below calculation is 97-100% sensitive for AIH². Specificity for exclusion of "definite AIH" amongst cases of hepatitis C and biliary-centric entities is 96-100% but 8-52% of those diseases achieved scores within the range stipulated for a diagnosis of "probable AIH"². The overall diagnostic accuracy of the scoring system in 938 cases is no less than 89.8%².

Parameter/feature	Points	Notes
1. ALP:AST (or ALT) ratio
<1.5	+2
1.5-3.0	0
>3.0	-2
2. Serum globulins (or IgG)
>2.0	+3
1.5-2.0	+2
1.0-1.5	+1
<1.0	0
3. ANA, ASMA, or LKM-1
>1:80	+3
1:80	+2
1:40	+1
<1:40	0
4. AMA positive	-4
5. Hepatitis viral markers
positive	-3
negative	+3
6. Drug history
positive	-4
negative	+1
7. Average alcohol intake
<25 g/day	+2
>60 g/day	-2
8. Liver histology
interface hepatitis	+3
predom. lymphoplasma.	+1
rosetting of liver cells	+1
none of the above	-5
biliary changes	-3
other changes	-3
9. Has other autoimmune dis.	+2
10. Optional addnl param.
seropos. other defined Abs	+2
HLA DR3 or DR4	+1
complete response to Tx	+2	see note 11
relapse after Tx	+3	see note 12
11. Female sex	+2
SUM of POINTS:	see below

Score Sum Interpretation:

if a pretreatment biopsy:
- >15........"definite AIH"
- 10-15....."probable AIH"
if a post-treatment biopsy [MUST see notes]:
- >17......."definite AIH"
- 12-17...."probable AIH"

References:

David Lewin, MUSC GI pathologist, e-mail in 2000.
Alvarez F, et. al., "International Autoimmune Hepatitis Group Report: review of criteria for diagnosis of autoimmune hepatitis", J. of Hepatology 31:929-938, 1999 [in EBSs office]

(posted 2001)