Filipovich et al developed criteria for the severity of chronic graft-versus-host disease (GVHD) for the National Institutes of Health. One of the criteria involved liver involvement.
Patient selection: chronic GVHD
Parameters:
(1) serum total bilirubin in mg/dL
(2) upper limit of normal reference range for serum total bilirubin in mg/dL
(3) serum alkaline phosphatase in U/L
(4) upper limit of normal reference range for serum alkaline phosphatase in U/L
(5) serum AST in IU/L
(6) upper limit of normal reference range for serum AST in IU/L
(7) serum ALT in IU/L
(8) upper limit of normal reference range for serum ALT in IU/L
ratio of test to upper limit of normal (ULN) reference range =
= (value) / (upper limit of normal for reference range)
|
Parameter |
Finding |
Grade |
|
serum total bilirubin |
value <= ULN |
0 |
|
|
ratio to ULN 1.01 to 1.99 |
1 |
|
|
value > 3 mg/dL |
2 |
|
|
ratio to ULN 2 to 5 |
2 |
|
|
ratio to ULN > 5 |
3 |
|
alkaline phosphatase |
value <= ULN |
0 |
|
|
ratio to ULN 1.01 to 1.99 |
1 |
|
|
ratio to ULN 2 to 5 |
2 |
|
|
ratio to ULN > 5 |
3 |
|
serum AST |
value <= ULN |
0 |
|
|
ratio to ULN 1.01 to 1.99 |
1 |
|
|
ratio to ULN 2 to 5 |
2 |
|
|
ratio to ULN > 5 |
3 |
|
serum ALT |
value <= ULN |
0 |
|
|
ratio to ULN 1.01 to 1.99 |
1 |
|
|
ratio to ULN 2 to 5 |
2 |
|
|
ratio to ULN > 5 |
3 |
where:
• In children serum alkaline phosphatase may be increased from bone isoenzyme. In this population may need to test for liver isoenzyme if the age and gender related reference ranges are insufficient.
grade for liver involvement =
= MAX(grade for the 4 serum analytes)
Specialty: Immunology/Rheumatology
