Revised IAHG Scoring System for Autoimmune Hepatitis

Parameters:

(1) gender

(2) ratio of alkaline phosphatase and AST

(3) serum globulin or IgG

(4) ANA, SMA and/or LKM-1 titer

(5) history of illicit drug use

(6) average daily alcohol intake

(7) histologic features (interface hepatitis, lymphoplasmacytic infiltrate, rosette formation, biliary changes, changes indicating another disease)

(8) other autoimmune disease

(9) antimitochrondrial antibody (AMA)

(10) viral hepatitis markers

where:

• A "standard" drink (1 ounce liquor, 1 glass wine, 1 12 oz. beer) has 10-15 grams alcohol

• Under alcohol consumption, Johnson (1993) has male 50-80 g/day etc. as -2 and male > 80 g/day etc as -1; I reversed the scores for the table above.

• The ratio of alkaline phosphatase to AST is taken after dividing by the upper limit of the normal reference range = ((alkaline phosphatase) / (ULN for alkaline phosphatase)) / ((AST) / (ULN for AST reference range))

Changes from original score:

(1) simplified scoring of daily alcohol intake

(2) change in exposure history

(3) simplified scoring of viral hepatitis markers

(4) expansion in the ratio of serum alkaline phosphatase to AST

(5) removal of autoantibodies in children

(6) change in score if AMA positive

(7) change in other autoimmune disease (previously genetic factors)

(8) point assignment for histologic features

(9) HLA haplotyptes not included

(10) response to treatment not included

total score =

= SUM(points for all of the parameters)

Interpretation:

• minimum score: -26

• maximum score: +23

• A high score is associated with autoimmune hepatitis.