cliot (version 1.0.0)

revised_original_aih_score: Revised Original Score for Autoimmune Hepatitis (1999)

Description

Calculates the 1999 Revised Original Score (International Autoimmune Hepatitis Group) for the diagnosis of Autoimmune Hepatitis (AIH). This comprehensive scoring system evaluates biochemical ratios, autoantibodies, viral markers, histology, and history to classify patients as having Probable or Definite AIH.

Usage

revised_original_aih_score(sex, alp_ast_ratio, globulin_igg_ratio,
                           autoantibody_titer, ama_positive,
                           viral_markers_positive, drug_history_positive,
                           alcohol_intake_low, histology_interface,
                           histology_plasma_cells, histology_rosettes,
                           histology_biliary, other_immune_disease,
                           hla_dr3_dr4, treatment_response = "none")

Value

A list containing:

AIH_Score

The calculated total score.

Diagnosis

Diagnostic classification (Definite >15, Probable 10-15, Unlikely <10).

Arguments

sex

String. "female" (+2 pts) or "male" (0 pts).

alp_ast_ratio

Numeric. Ratio of Alkaline Phosphatase to AST (relative to ULN). (<1.5: +2, 1.5-3.0: 0, >3.0: -2).

globulin_igg_ratio

Numeric. Ratio of Serum Globulins (or IgG) to the Upper Limit of Normal. (>2.0: +3, 1.5-2.0: +2, 1.0-1.5: +1, <1.0: 0).

autoantibody_titer

String. Titer of ANA, SMA, or Anti-LKM1. Options: "gt_1_80" (>1:80, +3), "1_80" (1:80, +2), "1_40" (1:40, +1), "lt_1_40" (<1:40, 0).

ama_positive

Numeric (0 or 1). Antimitochondrial Antibody positive? (1 = Yes, -4 pts).

viral_markers_positive

Numeric (0 or 1). Positive markers for active Hepatitis A, B, or C? (1 = Yes, -3 pts; 0 = No, +3 pts).

drug_history_positive

Numeric (0 or 1). History of hepatotoxic drug use? (1 = Yes, -4 pts; 0 = No, +1 pt).

alcohol_intake_low

Numeric (0 or 1). Average alcohol intake < 25 g/day? (1 = Yes, +2 pts; 0 = No, -2 pts).

histology_interface

Numeric (0 or 1). Interface hepatitis (piecemeal necrosis)? (1 = Yes, +3 pts).

histology_plasma_cells

Numeric (0 or 1). Predominantly lymphoplasmacytic infiltrate? (1 = Yes, +1 pt).

histology_rosettes

Numeric (0 or 1). Liver cell rosettes? (1 = Yes, +1 pt).

histology_biliary

Numeric (0 or 1). Biliary changes? (1 = Yes, -3 pts). (Note: If histology "None of above" is present, that is -5 pts, usually captured by entering 0 for all specific positives).

other_immune_disease

Numeric (0 or 1). Presence of other autoimmune diseases? (1 = Yes, +2 pts).

hla_dr3_dr4

Numeric (0 or 1). HLA DR3 or DR4 present? (1 = Yes, +1 pt).

treatment_response

String. Response to therapy (optional for pre-treatment score). "none" (0), "complete" (remission, +2), "relapse" (relapse after cessation, +3).

References

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. doi:10.1016/s0168-8278(99)80297-9

Examples

# Example 1: Definite AIH
# Female (+2), Low ALP ratio (+2), High IgG (+3), ANA 1:160 (+3), No viral/drugs/alcohol (+3+1+2)
# Interface (+3), Plasma (+1)
# Score = 2+2+3+3+3+1+2+3+1 = 20
revised_original_aih_score("female", 1.0, 2.5, "gt_1_80", 0, 0, 0, 1, 1, 1, 0, 0, 0, 0)

# Example 2: AIH Unlikely
# Male (0), Viral Pos (-3), Alcohol High (-2), Histology Biliary (-3)
# Score = -8 + baseline factors
revised_original_aih_score("male", 2.0, 1.0, "lt_1_40", 0, 1, 0, 0, 0, 0, 0, 1, 0, 0)