Xenobiotic Exposure and Autoimmune Hepatitis

Table 1

Revised scoring system of the international autoimmune hepatitis group.

Parameter	Factor	Score
Gender	Female	+2
Alk Phos: AST (or ALT) ratio	>3	−2
	<1.5	+2
Gamma-globulin or IgG level above normal	<1.0 to > 2.0	0 to +3*
ANA, SMA, or anti-LKM1 titers	<1:40 to >1:80	0 to +3*
AMA	Positive	−4
Viral markers of active infection	Positive	−3
	Negative	+3
Hepatotoxic drugs	Yes	−4
	No	+1
Alcohol	<25 g/d	+2
	>60 g/d	−2
Concurrent immune disease	Thyroiditis, colitis, other	+2
Other autoantibodies	Anti-SLA, -actin, -LC1, -pANCA	+2
Histologic features	Interface hepatitis	+3
	Plasma cells	+1
	Rosettes	+1
	None of above	−5
	Biliary changes	−3
	Atypical features	−3
HLA	DR3 or DR4	+1
Treatment response	Remission alone	+2
	Remission with relapse	+3
Pretreatment aggregate score
Definite diagnosis		>15
Probable diagnosis		10–15
Posttreatment aggregate score
Definite diagnosis		>17
Probable diagnosis		12–17

*Depends upon titer. Alk phos: serum alkaline phosphatase level; AST: aspartate aminotransferase; ALT: alanine aminotransferase; IgG: immunoglobulin G; ANA: antinuclear antibody; SMA: smooth muscle antibody; LKM: liver/kidney microsomes; SLA: soluble liver antigen; LC1: liver cytosol type 1; pANCA: perinuclear anti-neutrophil cytoplasmic antibody; HLA: human leukocyte antigen.