Calc Function

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    • Subcategory of 'Diagnosis' designed to be very sensitiveRule Out
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    • Numerical inputs and outputsFormula
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    Patent Pending

    Simplified Autoimmune Hepatitis (AIH) Score

    Diagnoses autoimmune hepatitis.
    Favorite
    When to Use
    Pearls/Pitfalls
    Why Use

    Patients with established hepatitis and available liver biopsy results, but unclear diagnosis.

    The Simplified Autoimmune Hepatitis (AIH) Score was developed to simplify AIH diagnosis and reduce false positive diagnoses.

    AIH is multifactorial, complex, and typically has many competing diagnoses. The score offers a data driven, consensus-based path to help guide treatment and is likely to be better than clinical judgment alone.

    Result:

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    Next Steps
    Evidence
    Creator Insights

    Advice

    AIH is a complex diagnosis partly because there is no anatomic criterion (i.e. ‘gold’) standard. AIH scoring neatly solves this problem by defining the diagnosis. ‘Definite’ scores appear highly reliable.

    Management

    We are unaware of validated management algorithms using the AIH scores.

    Critical Actions

    Overlap with multiple hepatic conditions is always a concern to consider despite score findings, and ‘definite’ scores are more predictive than ‘probable’ ones.

    Formula

    Addition of the selected points:

    Variable

    0 points

    1 point

    2 points

    ANA or SMA

    <1:40

    ≥1:40

    ≥1:80*

    LKM1

    <1:40

    --

    ≥1:40*

    SLA

    Negative

    --

    Positive*

    IgG

    Normal

    ≥Upper limit of normal

    ≥1.1× upper limit of normal

    Liver histology

    Normal

    Compatible with AIH

    Typical of AIH

    Viral hepatitis

    Present

    --

    Absent


    *Maximum 2 points total (e.g. if ANA or SMA ≥1:80 and SLA is positive, only 2 points are assigned, not 4).

    AIH, autoimmune hepatitis; ANA, antinuclear antibody; LKM1, Liver Kidney Microsome type 1; SLA, soluble liver antigen; SMA, smooth muscle antibody; IgG, immunoglobulin G.

    Facts & Figures

    Interpretation:

    Simplified AIH Score

    Diagnosis

    ≤5

    Possible AIH (though further testing should be done)

    6

    Probable AIH

    ≥7

    Definite AIH

    Evidence Appraisal

    The Simplified AIH score has been tested in a number of studies, including by comparison to its progenitor, the conventional score. Validations are typically in referral populations using database and chart review. The score is intended to improve specificity and reduce false positives over the conventional score, particularly in the ‘probable AIH’ category.

    Dr. Ansgar W. Lohse

    About the Creator

    Ansgar W. Lohse, MD, is Chairman of the Department of Medicine at the University Medical Center Hamburg-Eppendorf in Hamburg, Germany. He specializes in gastroenterology and infectious disease. Professor Lohse has authored over 300 peer-reviewed research papers in clinical and basic science hepatology.

    To view Dr. Ansgar W. Lohse's publications, visit PubMed