Dhawan et al developed a score for evaluating a patient with Wilson's disease and fulminant hepatitis. This is a revision to the modified score of Nazer et al. The authors are from King's College Hospital in London.
Patient selection: a child with Wilson's disease and fulminant hepatitis
Parameters:
(1) serum total bilirubin in µmol/L
(2) serum AST in IU/L
(3) INR (International Normalized Ratio)
(4) white blood cell count in 10^9/L
(5) serum albumin in g/L
|
Parameter |
Finding |
Points |
|
serum total bilirubin |
<= 100 µmol/L |
0 |
|
|
101 to 150 µmol/L |
1 |
|
|
151 to 200 µmol/L |
2 |
|
|
201 to 300 µmol/L |
3 |
|
|
> 300 |
4 |
|
serum AST |
<= 100 |
0 |
|
|
101 to 150 IU/L |
1 |
|
|
151 to 300 IU/L |
2 |
|
|
301 to 400 IU/L |
3 |
|
|
> 400 IU/L |
4 |
|
INR |
< 1.3 |
0 |
|
|
1.3 to 1.6 |
1 |
|
|
1.7 to 1.9 |
2 |
|
|
2.0 to 2.4 |
3 |
|
|
> 2.4 |
4 |
|
white blood cell count |
<= 6.7 |
0 |
|
|
6.8 to 8.3 |
1 |
|
|
8.4 to 10.3 |
2 |
|
|
10.4 to 15.3 |
3 |
|
|
> 15.3 |
4 |
|
serum albumin |
> 44 g/L |
0 |
|
|
34 to 44 g/L |
1 |
|
|
25 to 33 g/L |
2 |
|
|
21 to 24 g/L |
3 |
|
|
< 21 g/L |
4 |
where:
• The changes are assumed to be due to the liver disease and not another cause.
total score =
= SUM(points for all 5 parameters)
Interpretation:
• minimum score: 0
• maximum score: 20
• The higher the score the more severe the liver disease.
• A score >= 11 indicates a high risk of mortality without a liver transplantation.
Performance:
• A score >= 11 had a sensitivity of 93% and specificity of 97%. The positive predictive value was 92% and the negative predictive value was 97%.
Specialty: Gastroenterology
ICD-10: ,
