Scoring systems for the diagnosis of autoimmune hepatitis: past, present, and future

The diagnosis of autoimmune hepatitis (AIH) can be challenging due to the variable clinical and laboratory findings. The original diagnostic criteria published in 1993 by the International Autoimmune Hepatitis Group (IAIHG) were revised in 1999 in an attempt to standardize the diagnosis. However, these criteria are complex and can be cumbersome in clinical practice. In 2008, simplified diagnostic criteria were reported to facilitate the bedside diagnosis of AIH. The scoring systems have been evaluated in several retrospective case series and tested for their ability to reliably diagnose and exclude AIH. However, the scoring systems did not fare as well in patients with concomitant cholestatic disease, fatty liver disease, fulminant hepatitis, and pediatric patients. Both positive and negative predictive values are low in these patients. Prospective studies are needed to compare the two scoring systems to determine which (if not all) patients require liver biopsy and which patients would benefit from immunotherapy.