Comparison of the simplified criteria and conventional criteria for the diagnosis of autoimmune hepatitis

Objective The present study is to evaluate the accordance and discrepancy between the simplified criteria and conventional criteria for the diagnosis of autoimmune hepatitis (AIH) in Chinese patients.Methods The medical records of 63 AIH patients diagnosed by the conventional criteria in Peking Union Medical College Hospital from 1995 to 2010 were retrospectively reviewed and reevaluated by the simplified criteria.The accordance and discrepancy between the two criteria were identified.Results Among the 63 patients diagnosed by the conventional criteria, 55 were female and 8 were male, with an average age of 45.0±17.3 years.Thirty-six patients were diagnosed as definite AIH, among which 14 were diagnosed as definite AIH, 15 as probable AIH and 5 as not having AIH by the simplified criteria.Twenty-seven patients were diagnosed as probable AIH by the conventional criteria, among which 5 were diagnosed as definite AIH, 11 as probable AIH and 11 as not having AIH by the simplified criteria.The overall accordance rate between the two criteria was 71.4% (45/63) .Among the 33 patients with downgraded diagnosis, 24 had normal IgG levels, 21 had no liver biopsy, 19 had other defined autoantibodies and 14 had concomitant autoimmune diseases.Among the 5 patients with upgraded diagnosis, 2 were male, 1 had drug history, 2 had positive AMA and 5 had liver biopsy.Serum IgG level (P≤0.001) and pathological findings (P<0.001) were significantly different between the accordant and downgraded groups by both univariate and multivariate analyses.Conclusion The simplified criteria relies more on liver pathology and is suggested to be used in patients with typical clinical features.For those with atypical features but highly suspected as AIH, the conventional criteria is the criteria of choice.