Teran et al developed a discriminant score for identifying the presence of cirrhosis in a patient with chronic hepatitis. This can help identify patients who may or may not need a liver biopsy for diagnosis. The authors are from Case Western Reserve University in Cleveland.
NOTE: This score was the basis for score of Bonacini et al (see above).
Patient selection: The etiology of the chronic hepatitis was not used.
Parameters:
(1) platelet count per µL
(2) ALT to AST ratio
(3) prothrombin time prolongation (above the upper limit of normal reference range)
(4) ascites
(5) spider angiomas
ALT to AST ratio =
= (serum ALT) / (serum AST)
|
Parameter |
Finding |
Points |
|
platelet count per µL |
>= 340,000 per µL |
0 |
|
|
280,000 - 339,999 per µL |
1 |
|
|
220,000 - 279,999 per µL |
2 |
|
|
160,000 - 219,999 per µL |
3 |
|
|
100,000 - 159,999 per µL |
4 |
|
|
40,000 - 99,999 per µL |
5 |
|
|
< 40,000 per µL |
6 |
|
ALT to AST ratio |
>= 1.8 |
0 |
|
|
1.2 - 1.79 |
1 |
|
|
0.6 - 1.19 |
2 |
|
|
< 0.6 |
3 |
|
prothrombin time prolongation |
< 0.5 seconds |
0 |
|
|
0.5 - 3.5 seconds |
1 |
|
|
> 3.5 seconds |
2 |
|
ascites |
absent |
0 |
|
|
present |
2 |
|
spider angiomas |
absent |
0 |
|
|
present |
2 |
total discriminant score =
= SUM(points for all 5 parameters)
Interpretation:
• minimum score: 0
• maximum score: 15
• The higher the score the more likely cirrhosis is present.
|
Discriminant Score |
Likelihood of Cirrhosis |
|
0 - 5 |
< 7% |
|
6 - 9 |
indeterminate |
|
10 - 15 |
> 90% |
Performance using a cutoff of >= 7.5 as diagnosing cirrhosis:
• 75% of cirrhotics and 14% of noncirrhotics had scores >= 7.5.
• 25% of cirrhotics and 86% of noncirrhotics had scores < 7.5.
Purpose: To use the discriminant score of Teran et al to determine how likely cirrhosis is in a patient with chronic hepatitis.
Specialty: Gastroenterology, Infectious Diseases
Objective: other testing, criteria for diagnosis, selection
ICD-10: K74.6, K73.9,
