Autoimmune hepatitis scores

The two International Autoimmune Hepatitis Group (IAIHG) diagnostic scores. The simplified score is quicker and more specific. The revised original score takes more into account, and is more sensitive in atypical cases and after treatment has started.

Jump to the simplified score or the revised original score.

Simplified score (2008)

Answer all four items.

Simplified score	Interpretation
7 or 8	Definite autoimmune hepatitis
6	Probable autoimmune hepatitis
5 or less	Not diagnostic

Revised original score (1999)

Work out the ratios (optional)ALP U/LALP upper limit U/LAST or ALT U/LAST or ALT upper limit U/LGlobulins or IgG g/LGlobulins or IgG upper limit g/L

Change the upper limits to match your laboratory.

SexFemale (+2)Male (0)

ALP to AST (or ALT) ratio

Each as a multiple of its upper limit of normal: (ALP ÷ ULN) ÷ (AST ÷ ULN). Fill in the values above to choose automatically.

Below 1.5 (+2)1.5 to 3.0 (0)Above 3.0 (−2)

Globulins or IgG, times the upper limit of normalAbove 2.0 (+3)1.5 to 2.0 (+2)1.0 to 1.5 (+1)Below 1.0 (0)

ANA, SMA or LKM-1 titre

Adult titres, by immunofluorescence on rodent tissue.

Above 1:80 (+3)1:80 (+2)1:40 (+1)Below 1:40 (0)

Antimitochondrial antibodyPositive (−4)Negative (0)

Markers of active viral hepatitis (A, B, C)Positive (−3)Negative (+3)

Recent or current hepatotoxic drug useYes (−4)No (+1)

Average alcohol intakeUnder 25 g a day (+2)25 to 60 g a day (0)Over 60 g a day (−2)

Other autoimmune disease in the patient or a first-degree relativeYes (+2)No (0)

Response to treatment

Leave as not yet treated to use the pre-treatment cut-offs.

Not yet treated (0)Complete response (+2)Relapse after a complete response (+3)Partial or no response (0)

Liver histology Biopsy done No biopsy

Optional additional parametersOther defined autoantibodies: SLA, LC-1, pANCA, ASGPR, LP or sulfatide (+2)HLA DR3 or DR4 (+1)

Answer the items above.

Revised original score	Before treatment	After treatment
Definite	Above 15	Above 17
Probable	10 to 15	12 to 17
Not diagnostic	Below 10	Below 12

Notes

Neither score replaces clinical judgement. Both were designed to standardise diagnosis in research, and can miss acute or atypical presentations, including drug-induced autoimmune-like hepatitis.
The simplified score needs a liver biopsy; without histology the maximum is 6.
The revised original score is less specific in cholestatic disease and overlap syndromes with PBC or PSC. Neither score should be used to diagnose an overlap syndrome.
Titres here are the adult cut-offs. Lower titres are significant in children.

References

Hennes EM, Zeniya M, Czaja AJ, et al. Simplified criteria for the diagnosis of autoimmune hepatitis. Hepatology. 2008;48(1):169-176.

Alvarez F, Berg PA, Bianchi FB, et al. International Autoimmune Hepatitis Group Report: review of criteria for diagnosis of autoimmune hepatitis. J Hepatol. 1999;31(5):929-938.