Severity Indices for Fulminant Non-A, Non-B Viral Hepatitis

 

Evaluation: A patient with fulminant non-A, non-B viral hepatitis on the day of onset for encephalitis.

 

Parameters:

(1) total bilirubin

(2) ratio of total to direct bilirubin

(3) age in years

(4) white blood cell count

(5) duration of illness prior to onset of encephalopathy

(6) serum ALT relative to the upper limit of normal

 

ratio of total to direct serum bilirubin =

= (total serum bilirubin) / (direct serum bilirubin)

 

ratio of serum ALT to the upper limit of normal =

= (serum ALT) / (upper limit of normal)

Parameter	Finding	Points
total bilirubin	<= 15 mg/dL	0
	> 15 mg/dL1
ratio of total to direct bilirubin	<= 1.5	0
	> 1.5	1
duration of illness	< 4 days	1
	4 to 12 days	0
	> 12 days	1
ratio of serum ALT to ULN	<= 40	0
	> 40	1
age of the patient in years	<= 50 years	0
	> 50 years	1

 

total score =

= (2.25 * (points for total bilirubin)) + (2.66 * (points for total to direct bilirubin ratio)) + (2.24 * (points for illness duration)) + (2.05 * (points for ALT ratio)) + (1.38 * (points for age)) + (0.00021 * (WBC count)) - 6.33

 

Interpretation:

• The cutoff is > 0, with a positive score associated with increased mortality (identified 92% of the patients who died).

• This can help identify a patient who should be evaluated for liver transplant early in the clinical course.

 

Performance:

• The sensitivity was 95% and specificity 70%.

• The positive predictive value is 92% and the negative predictive value is 78%.