Pediatric Gastroenterology, Hepatology & Nutrition

The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition (대한소아소화기영양학회)
권호 표지
DOI QR코드

DOI QR Code

Accuracy of the 2008 Simplified Criteria for the Diagnosis of Autoimmune Hepatitis in Children

  • Arcos-Machancoses, Jose Vicente (Department of Pediatric Gastroenterology, Hepatology and Nutrition, Sant Joan de Deu Hospital (SJDH)) ;
  • Busoms, Cristina Molera (Department of Pediatric Gastroenterology, Hepatology and Nutrition, Sant Joan de Deu Hospital (SJDH)) ;
  • Tatis, Ecaterina Julio (Department of Pediatric Gastroenterology, Hepatology and Nutrition, Sant Joan de Deu Hospital (SJDH)) ;
  • Bovo, Maria Victoria (Department of Pediatric Gastroenterology, Hepatology and Nutrition, Sant Joan de Deu Hospital (SJDH)) ;
  • Bernabeu, Jesus Quintero (Department of Pediatric Gastroenterology and Hepatology, Vall d'Hebron Hospital (VHH)) ;
  • Goni, Javier Juamperez (Department of Pediatric Gastroenterology and Hepatology, Vall d'Hebron Hospital (VHH)) ;
  • Martinez, Vanessa Crujeiras (Department of Pediatric Gastroenterology and Hepatology, University Hospital Complex of Santiago de Compostela) ;
  • Martin de Carpi, Javier (Department of Pediatric Gastroenterology, Hepatology and Nutrition, Sant Joan de Deu Hospital (SJDH))
  • Received : 2017.10.13
  • Accepted : 2017.12.18
  • Published : 2018.04.15
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: Classical criteria for diagnosis of autoimmune hepatitis (AIH) are intended as research tool and are difficult to apply at patient's bedside. We aimed to study the accuracy of simplified criteria and the concordance with the expert diagnosis based on the original criteria. Methods: A cohort of children under study for liver disorder was selected through consecutive sampling to obtain the prevalence of AIH within the group of differential diagnoses. AIH was defined, based on classical criteria, through committee review of medical reports. Validity indicators of the simplified criteria were obtained in an intention to diagnose approach. Optimal cut-off and the area under the receiver operating characteristic (ROC) curve were calculated. Results: Out of 212 cases reviewed, 47.2% were AIH. For the optimal cut-off (6 points), the simplified criteria showed a sensitivity of 72.0% and a specificity of 96.4%, with a 94.7% positive and a 79.4% negative predictive value. The area under the ROC curve was 94.3%. There was a good agreement in the pre-treatment concordance between the classical and the simplified criteria (kappa index, 0.775). Conclusion: Simplified criteria provide a moderate sensitivity for the diagnosis of AIH, but may help in indicating treatment in cases under suspicion with 6 or more points.

Keywords

References

  1. Krawitt EL. Clinical features and management of autoimmune hepatitis. World J Gastroenterol 2008;14:3301-5. https://doi.org/10.3748/wjg.14.3301
  2. Vergani D, Mieli-Vergani G. Cutting edge issues in autoimmune hepatitis. Clin Rev Allergy Immunol 2012;42:309-21. https://doi.org/10.1007/s12016-010-8236-9
  3. Mieli-Vergani G, Vergani D. Autoimmune hepatitis in children: what is different from adult AIH? Semin Liver Dis 2009;29:297-306. https://doi.org/10.1055/s-0029-1233529
  4. Della Corte C, Sartorelli MR, Sindoni CD, Girolami E, Giovannelli L, Comparcola D, et al. Autoimmune hepatitis in children: an overview of the disease focusing on current therapies. Eur J Gastroenterol Hepatol 2012;24:739-46. https://doi.org/10.1097/MEG.0b013e328353750c
  5. Johnson PJ, McFarlane IG. Meeting report: International Autoimmune Hepatitis Group. Hepatology 1993;18:998-1005. https://doi.org/10.1002/hep.1840180435
  6. Alvarez F, Berg PA, Bianchi FB, Bianchi L, Burroughs AK, Cancado EL, et al. International Autoimmune Hepatitis Group Report: review of criteria for diagnosis of autoimmune hepatitis. J Hepatol 1999;31:929-38. https://doi.org/10.1016/S0168-8278(99)80297-9
  7. Ebbeson RL, Schreiber RA. Diagnosing autoimmune hepatitis in children: is the International Autoimmune Hepatitis Group scoring system useful? Clin Gastroenterol Hepatol 2004;2:935-40. https://doi.org/10.1016/S1542-3565(04)00396-9
  8. Hennes EM, Zeniya M, Czaja AJ, Pares A, Dalekos GN, Krawitt EL, et al. Simplified criteria for the diagnosis of autoimmune hepatitis. Hepatology 2008;48:169-76. https://doi.org/10.1002/hep.22322
  9. Choi G, Peters MG. The challenge of diagnosing autoimmune hepatitis: less is more. Hepatology 2008;48:10-2. https://doi.org/10.1002/hep.22438
  10. Qiu D, Wang Q, Wang H, Xie Q, Zang G, Jiang H, et al. Validation of the simplified criteria for diagnosis of autoimmune hepatitis in Chinese patients. J Hepatol 2011;54:340-7. https://doi.org/10.1016/j.jhep.2010.06.032
  11. Li Y, Peng M, Gong G. Evaluation of the revised versus the simplified scoring system in patients with autoimmune hepatitis. Exp Ther Med 2014;7:131-6. https://doi.org/10.3892/etm.2013.1366
  12. Fujiwara K, Yasui S, Tawada A, Fukuda Y, Nakano M, Yokosuka O. Diagnostic value and utility of the simplified International Autoimmune Hepatitis Group criteria in acute-onset autoimmune hepatitis. Liver Int 2011;31:1013-20. https://doi.org/10.1111/j.1478-3231.2011.02524.x
  13. Liu F, Pan ZG, Ye J, Xu D, Guo H, Li GP, et al. Primary biliary cirrhosis-autoimmune hepatitis overlap syndrome: simplified criteria may be effective in the diagnosis in Chinese patients. J Dig Dis 2014;15:660-8. https://doi.org/10.1111/1751-2980.12196
  14. Gatselis NK, Zachou K, Papamichalis P, Koukoulis GK, Gabeta S, Dalekos GN, et al. Comparison of simplified score with the revised original score for the diagnosis of autoimmune hepatitis: a new or a complementary diagnostic score? Dig Liver Dis 2010;42:807-12. https://doi.org/10.1016/j.dld.2010.03.005
  15. Yeoman AD, Westbrook RH, Al-Chalabi T, Carey I, Heaton ND, Portmann BC, et al. Diagnostic value and utility of the simplified International Autoimmune Hepatitis Group (IAIHG) criteria in acute and chronic liver disease. Hepatology 2009;50:538-45.
  16. Muratori P, Granito A, Pappas G, Muratori L. Validation of simplified diagnostic criteria for autoimmune hepatitis in Italian patients. Hepatology 2009;49:1782-3; author reply 1783. https://doi.org/10.1002/hep.22825
  17. Hiejima E, Komatsu H, Sogo T, Inui A, Fujisawa T. Utility of simplified criteria for the diagnosis of autoimmune hepatitis in children. J Pediatr Gastroenterol Nutr 2011;52:470-3. https://doi.org/10.1097/MPG.0b013e3181fc1e0b
  18. Mileti E, Rosenthal P, Peters MG. Validation and modification of simplified diagnostic criteria for autoimmune hepatitis in children. Clin Gastroenterol Hepatol 2012;10:417-21.e1-2. https://doi.org/10.1016/j.cgh.2011.11.030
  19. Squires RH Jr, Shneider BL, Bucuvalas J, Alonso E, Sokol RJ, Narkewicz MR, et al. Acute liver failure in children: the first 348 patients in the pediatric acute liver failure study group. J Pediatr 2006;148:652-8. https://doi.org/10.1016/j.jpeds.2005.12.051
  20. Kochar R, Fallon M. Diagnostic criteria for autoimmune hepatitis: what is the gold standard? Hepatology 2010;51:350-1; author reply 351. https://doi.org/10.1002/hep.23446
  21. Czaja AJ. Comparability of probable and definite autoimmune hepatitis by international diagnostic scoring criteria. Gastroenterology 2011;140:1472-80. https://doi.org/10.1053/j.gastro.2011.02.010
  22. Tiniakos DG, Brain JG, Bury YA. Role of histopathology in autoimmune hepatitis. Dig Dis 2015;33 Suppl 2:53-64. https://doi.org/10.1159/000440747
  23. Schuetz GM, Schlattmann P, Dewey M. Use of 3x2 tables with an intention to diagnose approach to assess clinical performance of diagnostic tests: meta-analytical evaluation of coronary CT angiography studies. BMJ 2012;345:e6717. https://doi.org/10.1136/bmj.e6717
  24. Good IJ. Weight of evidence: A brief survey. Bayesian Stat 1985;2:249-70.
  25. Zweig MH, Campbell G. Receiver-operating characteristic (ROC) plots: a fundamental evaluation tool in clinical medicine. Clin Chem 1993;39:561-77.
  26. Buderer NM. Statistical methodology: I. Incorporating the prevalence of disease into the sample size calculation for sensitivity and specificity. Acad Emerg Med 1996;3:895-900. https://doi.org/10.1111/j.1553-2712.1996.tb03538.x
  27. Stalpers LJ, Nelemans PJ, Geurts SM, Jansen E, de Boer P, Verbeek AL. The indication area of a diagnostic test. Part I--discounting gain and loss in diagnostic certainty. J Clin Epidemiol 2015;68:1120-8. https://doi.org/10.1016/j.jclinepi.2015.05.016
  28. Manns MP, Czaja AJ, Gorham JD, Krawitt EL, Mieli-Vergani G, Vergani D, et al. Diagnosis and management of autoimmune hepatitis. Hepatology 2010;51:2193-213. https://doi.org/10.1002/hep.23584
  29. Bjornsson E, Talwalkar J, Treeprasertsuk S, Neuhauser M, Lindor K. Patients with typical laboratory features of autoimmune hepatitis rarely need a liver biopsy for diagnosis. Clin Gastroenterol Hepatol 2011;9:57-63. https://doi.org/10.1016/j.cgh.2010.07.016
  30. Czaja AJ. Performance parameters of the diagnostic scoring systems for autoimmune hepatitis. Hepatology 2008;48:1540-8. https://doi.org/10.1002/hep.22513
  31. Mieli-Vergani G, Heller S, Jara P, Vergani D, Chang MH, Fujisawa T, et al. Autoimmune hepatitis. J Pediatr Gastroenterol Nutr 2009;49:158-64. https://doi.org/10.1097/MPG.0b013e3181a1c265
  32. Gregorio GV, Portmann B, Karani J, Harrison P, Donaldson PT, Vergani D, et al. Autoimmune hepatitis/sclerosing cholangitis overlap syndrome in childhood: a 16-year prospective study. Hepatology 2001;33:544-53. https://doi.org/10.1053/jhep.2001.22131
  33. Czaja AJ, Freese DK; American Association for the Study of Liver Disease. Diagnosis and treatment of autoimmune hepatitis. Hepatology 2002;36:479-97. https://doi.org/10.1053/jhep.2002.34944
  34. Kaya M, Angulo P, Lindor KD. Overlap of autoimmune hepatitis and primary sclerosing cholangitis: an evaluation of a modified scoring system. J Hepatol 2000;33:537-42. https://doi.org/10.1016/S0168-8278(00)80004-5
  35. Papamichalis PA, Zachou K, Koukoulis GK, Veloni A, Karacosta EG, Kypri L, et al. The revised international autoimmune hepatitis score in chronic liver diseases including autoimmune hepatitis/overlap syndromes and autoimmune hepatitis with concurrent other liver disorders. J Autoimmune Dis 2007;4:3. https://doi.org/10.1186/1740-2557-4-3
  36. Chandok N, Silveira MG, Lindor KD. Comparing the simplified and international autoimmune hepatitis group criteria in primary sclerosing cholangitis. Gastroenterol Hepatol (N Y) 2010;6:108-12.

Cited by

  1. Case Report: Acute Hepatitis E in a Pediatric Traveler Presenting with Features of Autoimmune Hepatitis: A Diagnostic and Therapeutic Challenge vol.100, pp.1, 2018, https://doi.org/10.4269/ajtmh.18-0640
  2. Diagnosing autoimmune hepatitis in paediatric patients - we still haven’t found what we are looking for vol.108, pp.9, 2018, https://doi.org/10.1111/apa.14890