Poynard et al developed a simple biological index based on laboratory tests to identify alcoholic liver disease in patients who regularly consume alcohol. This may help reduce the need for liver biopsy in these patients. The authors are from Hopital Antoine Beclere in Clamart, France.
NOTE: As alternative form of the PGA Index is given in 11.04.07, which uses the INR rather than the prothrombin time.
Patient selection: The patients included in the study drank at least 50 grams of alcohol per day for the previous 5 years.
Parameters ("PGA"):
(1) Prothrombin Time (PT)
(2) GGT, serum (gamma-glutamyltranspeptidase or gamma-glutamyltransferase)
(3) Apolipoprotein A-1 (Apo A-I)
|
Parameter |
Finding |
Points |
|
(prothrombin time for patient in seconds) – (upper limit of prothrombin control in seconds) |
< 1 second |
0 |
|
|
1 – 1.99 seconds |
1 |
|
|
2 – 2.99 seconds |
2 |
|
|
3 – 3.99 seconds |
3 |
|
|
>= 4 seconds |
4 |
|
serum GGT |
< 20 IU/L |
0 |
|
|
20 – 49 IU/L |
1 |
|
|
50 – 99 IU/L |
2 |
|
|
100 – 199 IU/L |
3 |
|
|
>= 200 IU/L |
4 |
|
serum Apolipoprotein A-I |
>= 200 mg/dL |
0 |
|
|
175 – 199 mg/dL (87.5-99% LLN) |
1 |
|
|
150 – 174 mg/dL (75-87% LLN) |
2 |
|
|
125 – 149 mg/dL (63-74% LLN) |
3 |
|
|
< 125 mg/dL (< 63% LLN) |
4 |
from Table 2, page 1399
where:
• The prothrombin time can also be scored based on the percent (0 points for >= 80%; 1 point for 70-79%; 2 points for 60-69%; 3 points for 50 – 59%; 4 points for < 50%). This probably refers to the prothrombin activity based on the prothrombin time seen with the dilution curve.
• The values for Apo A-I in Table 2 are listed in g/dL, yet as mg/dL in Table 3 on the same page. The latter is more consistent with the values given by Tietz in Clinical Guide to Laboratory Tests .
• The method used by the current authors is an EIA kit from Sebia in France. The reference range was not given.
• The normal range for Apo A-I given in Tietz is given as 81-169 mg/dL for a 50-59 year old male.
total PGA index =
= SUM(points for all 3 parameters)
Interpretation:
• minimum score: 0
• maximum score: 12
• The higher the score the greater the likelihood of alcoholic cirrhosis.
• The score was correlated with the probability of histologic changes on liver biopsy, as shown in the following table.
|
PGA Index |
Probability Normal or Minimal Change |
Probability of Alcoholic Hepatitis or Fibrosis |
Probability of Cirrhosis |
|
0 – 2 |
83-93% |
7-17% |
0% |
|
3 – 5 |
60-61% |
31% |
8-9% |
|
6 – 8 |
23-27% |
26-27% |
46-51% |
|
9 - 12 |
0% |
14-21% |
79-86% |
from Table 4, page 400 (range reflects training and validation periods)
Purpose: To estimate the risk of alcoholic liver diseaes based on the simple biological PGA index of Poynard et al.
Specialty: Gastroenterology, Toxicology
Objective: laboratory tests, other testing, selection
ICD-10: K70.9, F10.2,
