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Diagnostic and prognostic scoring systems for autoimmune hepatitis : a review

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Abstract
Introduction: Auto-immune hepatitis (AIH) is a rare condition which primarily affects young women. Several diagnostic scoring systems exist based on clinical, biochemical, immunologic and histologic characteristics of AIH. Additionally, prognostic parameters can be identified. The purpose of this literature review is to compare the clinical value, strengths and limitations of these diagnostic and prognostic scoring systems. Methods: A literature search was performed in two databases and selected based on diagnostic and prognostic criteria. Only studies concerning AIH in adults were included. Results: The backbone of scoring systems remains the revised AIH criteria published in 1999 and the simplified from 2008. The revised system shows a higher sensitivity, lower specificity and lower diagnostic accuracy compared to the simplified. Limitations to these scoring systems include limited diagnostic accuracy in acute or fulminant liver failure, insufficient inclusion of atypical auto-antibodies and lacking diagnostic power in presence of overlap syndromes. Concerning these overlap syndromes, the Paris criteria show a higher diagnostic accuracy compared to the scoring systems for AIH. Presently, no clinical prognostic scoring systems are available. However, a first system based on response to treatment accurately predicts long-term survival in AIH. Conclusion: Diagnostic scoring systems are useful in diagnosing AIH and have complementary value. However, they are no substitute for the gold standard of appropriate clinical assessment and are mostly useful in defining cohorts for research purposes. An evolution towards a more dynamic scoring system, using prognostic parameters and the progression of typical features, seems more valuable than the current diagnostic systems.
Keywords
autoimmune hepatitis, diagnosis, scoring system, prognosis, LIVER-TRANSPLANTATION, SIMPLIFIED CRITERIA, CLINICAL-FEATURES, MANAGEMENT, CIRRHOSIS, UTILITY, DISEASE

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MLA
Ducazu, Olivier, et al. “Diagnostic and Prognostic Scoring Systems for Autoimmune Hepatitis : A Review.” ACTA GASTRO-ENTEROLOGICA BELGICA, vol. 84, no. 3, 2021, pp. 487–95, doi:10.51821/84.3.014.
APA
Ducazu, O., Degroote, H., Geerts, A., Hoorens, A., Schouten, J., Van Vlierberghe, H., & Verhelst, X. (2021). Diagnostic and prognostic scoring systems for autoimmune hepatitis : a review. ACTA GASTRO-ENTEROLOGICA BELGICA, 84(3), 487–495. https://doi.org/10.51821/84.3.014
Chicago author-date
Ducazu, Olivier, Helena Degroote, Albert Geerts, Anne Hoorens, J. Schouten, Hans Van Vlierberghe, and Xavier Verhelst. 2021. “Diagnostic and Prognostic Scoring Systems for Autoimmune Hepatitis : A Review.” ACTA GASTRO-ENTEROLOGICA BELGICA 84 (3): 487–95. https://doi.org/10.51821/84.3.014.
Chicago author-date (all authors)
Ducazu, Olivier, Helena Degroote, Albert Geerts, Anne Hoorens, J. Schouten, Hans Van Vlierberghe, and Xavier Verhelst. 2021. “Diagnostic and Prognostic Scoring Systems for Autoimmune Hepatitis : A Review.” ACTA GASTRO-ENTEROLOGICA BELGICA 84 (3): 487–495. doi:10.51821/84.3.014.
Vancouver
1.
Ducazu O, Degroote H, Geerts A, Hoorens A, Schouten J, Van Vlierberghe H, et al. Diagnostic and prognostic scoring systems for autoimmune hepatitis : a review. ACTA GASTRO-ENTEROLOGICA BELGICA. 2021;84(3):487–95.
IEEE
[1]
O. Ducazu et al., “Diagnostic and prognostic scoring systems for autoimmune hepatitis : a review,” ACTA GASTRO-ENTEROLOGICA BELGICA, vol. 84, no. 3, pp. 487–495, 2021.
@article{8738085,
  abstract     = {{Introduction: Auto-immune hepatitis (AIH) is a rare condition which primarily affects young women. Several diagnostic scoring systems exist based on clinical, biochemical, immunologic and histologic characteristics of AIH. Additionally, prognostic parameters can be identified. The purpose of this literature review is to compare the clinical value, strengths and limitations of these diagnostic and prognostic scoring systems.

Methods: A literature search was performed in two databases and selected based on diagnostic and prognostic criteria. Only studies concerning AIH in adults were included.

Results: The backbone of scoring systems remains the revised AIH criteria published in 1999 and the simplified from 2008. The revised system shows a higher sensitivity, lower specificity and lower diagnostic accuracy compared to the simplified. Limitations to these scoring systems include limited diagnostic accuracy in acute or fulminant liver failure, insufficient inclusion of atypical auto-antibodies and lacking diagnostic power in presence of overlap syndromes. Concerning these overlap syndromes, the Paris criteria show a higher diagnostic accuracy compared to the scoring systems for AIH. Presently, no clinical prognostic scoring systems are available. However, a first system based on response to treatment accurately predicts long-term survival in AIH.

Conclusion: Diagnostic scoring systems are useful in diagnosing AIH and have complementary value. However, they are no substitute for the gold standard of appropriate clinical assessment and are mostly useful in defining cohorts for research purposes. An evolution towards a more dynamic scoring system, using prognostic parameters and the progression of typical features, seems more valuable than the current diagnostic systems.}},
  author       = {{Ducazu, Olivier and Degroote, Helena and Geerts, Albert and Hoorens, Anne and Schouten, J. and Van Vlierberghe, Hans and Verhelst, Xavier}},
  issn         = {{1784-3227}},
  journal      = {{ACTA GASTRO-ENTEROLOGICA BELGICA}},
  keywords     = {{autoimmune hepatitis,diagnosis,scoring system,prognosis,LIVER-TRANSPLANTATION,SIMPLIFIED CRITERIA,CLINICAL-FEATURES,MANAGEMENT,CIRRHOSIS,UTILITY,DISEASE}},
  language     = {{eng}},
  number       = {{3}},
  pages        = {{487--495}},
  title        = {{Diagnostic and prognostic scoring systems for autoimmune hepatitis : a review}},
  url          = {{http://dx.doi.org/10.51821/84.3.014}},
  volume       = {{84}},
  year         = {{2021}},
}

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