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PGAA Index for Evaluating Patient with Alcoholic Liver Disease

Purpose: To evaluate a patient with alcoholic liver disease using the PGAA index of Naveau et al.

Description

Naveau et al modified the PGA index by the addition of serum alpha-2-macroglobulin for evaluation of a patient with alcoholic liver disease. This can help identify patients who may have alcoholic cirrhosis. The authors are from Hopital Antione Beclere in France.


 

Alpha-2-macroglobulin is a proteinase inhibitor that may contribute to the development of fibrosis in the liver.

 

NOTE: The PGA index is described in 11.04.07 and 11.07.07.

 

Parameters:

(1) prothrombin activity as percent of control

(2) GGT in IU/L

(3) apolipoprotein A1 in mg/dL

(4) alpha-2-macroglobulin in g/L

 

Parameter

Finding

Points

prothrombin activity

>= 80% of normal control

0

 

70 - 79%

1

 

60 - 69%

2

 

50 - 59%

3

 

< 50%

4

GGT

< 20 IU/L

0

 

20 - 49 IU/L

1

 

50 - 99 IU/L

2

 

100 - 199 IU/L

3

 

>= 200 IU/L

4

apolipoprotein A1

>= 200 mg/dL

0

 

175 - 199 mg/dL

1

 

150 - 174 mg/dL

2

 

125 - 149 mg/dL

3

 

< 125 mg/dL

4

alpha-2-macroglobulin

< 1.25 g/L

0

 

1.25 - 1.74 g/L

1

 

1.75 - 2.24 g/L

2

 

2.25 - 2.74 g/L

3

 

>= 2.75 g/L

4

 

where:

• The prothrombin activity is referred to as "prothrombin time". However, the usage indicates the activity seen on dilution or decrease in the coagulation factors. This is usually done by serially diluting a sample and measuring the corresponding prothrombin time which maps percent activity to PT in seconds. Alternatively the INR can be used.

• A value of 0 is assigned for normal values.

 

total PGAA index =

= SUM(points for all 4 parameters)

 

Interpretation:

• minimum score: 0

• maximum score: 16

• The higher the score the greater the risk of significant alcoholic liver disease.

PGAA Index

% with no or minimal change

% with hepatitis or fibrosis

% with cirrhosis

0 - 3

93%

7%

0%

4 - 7

69%

26%

5%

8 - 11

26%

28%

46%

12 - 16

0%

8%

92%

from Table 6, page 2430

 

Performance:

• The ROC curves are given in Figures 1 and 2 on page 2430.

• A PGAA index >= 7 had a sensitivity of 89% and specificity of 79% for the diagnosis of cirrhosis (page 2429).

 


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Specialty

Objective

ICD-10