Comparison of simplified score with the revised original score for the diagnosis of autoimmune hepatitis: a new or a complementary diagnostic score?
OBJECTIVE
The International Autoimmune Hepatitis Group developed a simplified score for autoimmune hepatitis. We assessed this "new scoring system" and compared it with the International Autoimmune Hepatitis Group original revised score.


METHODS
502 patients were evaluated namely, 428 had liver diseases of various etiology [hepatitis B (n=109), hepatitis C (n=100), hepatitis D (n=4), alcoholic liver disease (n=28), non-alcoholic fatty liver disease (n=55), autoimmune cholestatic diseases (n=77), liver disorders of undefined origin (n=32) and miscellaneous hepatic disorders (n=23)], 13 had autoimmune hepatitis/overlap syndromes, 18 had autoimmune hepatitis/concurrent with other liver diseases and 43 had autoimmune hepatitis.


RESULTS
The specificity of the simplified score was similar to that of the revised score (97% vs. 97.9%). The sensitivity in unmasking autoimmune hepatitis in autoimmune hepatitis/overlap syndromes was also similar in both systems (53.8% and 61.5%). However, the sensitivity for autoimmune hepatitis diagnosis in autoimmune hepatitis patients with concurrent liver disorders was lower by the new score (p=0.001). Liver biopsy proved to be the only independent factor for unmasking autoimmune hepatitis component among patients (p=0.003).


CONCLUSIONS
The simplified score is a reliable and simple tool for excluding autoimmune hepatitis. However, both systems cannot unmask autoimmune hepatitis component efficiently in autoimmune hepatitis patients with concurrent autoimmune or non-autoimmune liver diseases. This study also strongly reiterates the importance of liver biopsy in the work-up of patients.
Gatselis
Nikolaos K
NK
Department of Medicine and Research Laboratory of Internal Medicine, Medical School, University of Thessaly, Greece.
Zachou
Kalliopi
K
Papamichalis
Panagiotis
P
Koukoulis
George K
GK
Gabeta
Stella
S
Dalekos
George N
GN
Rigopoulou
Eirini I
EI
D000328:Adult; D000368:Aged; D001323:Autoantibodies / Q000097:blood; D001706:Biopsy; D002908:Chronic Disease; D003937:Diagnosis, Differential; D034462:Dissent and Disputes; D005260:Female; D006115:Greece; D019983:Guideline Adherence; D019693:Hepatitis, Autoimmune / Q000097:blood / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology; D006801:Humans; D008099:Liver / Q000473:pathology; D008107:Liver Diseases / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
D001323:Autoantibodies