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MELD-NaAssesses the severity of chronic liver diseaseChild-Pugh ScoreAssesses the prognosis of chronic liver disease, mainly cirrhosisFIB-4 IndexLiver fibrosis scoring indexAPRIAST to platelet ratio — liver fibrosisMaddrey's DFAlcoholic hepatitis severityGlasgow-BlatchfordUpper GI bleed risk stratificationGAHSGlasgow alcoholic hepatitis scoreMontreal IBDIBD classification — CD & UCMayo ScoreUlcerative colitis activityBISAP ScoreBedside index for severity of pancreatitisCLIF-SOFAOrgan failure scoring in cirrhosisAlcohol ContentStandard drinks & alcohol grams calculatorAARC-ACLFAcute-on-chronic liver failure gradePELD / CR ScorePediatric end-stage liver diseaseHarvey-BradshawCrohn's disease activity indexCTSICT severity index — pancreatitisRockall ScoreGI bleed rebleeding & mortality riskCAGEAlcohol use disorder screening (4 questions)MELD 3.0Updated MELD — sex-inclusive formulaAUDIT ScoreAlcohol use disorders identification testVOCAL-Penn ScorePost-operative mortality risk in cirrhosis surgery

Liver & Cirrhosis

17
ALBI GradeAlbumin-bilirubin liver function grade in HCCUKELD ScoreUK model for end-stage liver diseaseMELD-XIMELD excluding INR — for anticoagulated patientsWest Haven CriteriaHepatic encephalopathy gradingMilan CriteriaLiver transplant eligibility in hepatocellular carcinomaLI-RADS v2018 (CT/MRI)Liver observation category from size, APHE and major featuresBCLC StagingHepatocellular carcinoma stage and treatment allocationSimplified AIH CriteriaSimplified criteria for autoimmune hepatitisRevised Original AIH ScoreIAIHG 1999 comprehensive autoimmune hepatitis scoreSAAGSerum-ascites albumin gradient — cause of ascitesR FactorHepatocellular vs cholestatic pattern in liver injuryCLIF-C ACLFMortality prediction in acute-on-chronic liver failureKing's College CriteriaTransplant criteria in acute liver failureGALAD ScoreHCC detection from gender, age, AFP-L3, AFP and DCPMetroticket 2.0AFP-adjusted up-to-seven for HCC transplant eligibilityRUCAMCausality in drug- and herb-induced liver injuryBaveno VII CriteriacACLD, CSPH and sparing screening endoscopy

Fibrosis & MASLD

8
NAFLD Fibrosis ScoreAdvanced fibrosis probability in MASLD/NAFLDBARD ScoreBMI, AST/ALT ratio, diabetes — MASLD fibrosisFatty Liver IndexPredicts hepatic steatosis from routine labsFibrotic NASH Index (FNI)At-risk NASH probability from AST, HbA1c and HDLNAFLD Activity Score (NAS)Histologic activity grade — steatosis, inflammation, ballooningMEFIB IndexMRE + FIB-4 rule for significant fibrosis (≥F2) in MASLDFAST ScoreFibroScan-AST — at-risk NASH from LSM, CAP and ASTSAFE ScoreSteatosis-Associated Fibrosis Estimator for MASLD in primary care

Pancreas & Biliary

8
Ranson's CriteriaAcute pancreatitis severity at 48 hoursGlasgow-Imrie CriteriaAcute pancreatitis severity — the PANCREAS criteriaHAPSHarmless acute pancreatitis scoreTokyo Guidelines — CholangitisTG18 diagnosis and severity grade for acute cholangitisTokyo Guidelines — CholecystitisTG18 diagnosis and severity grade for acute cholecystitisBiliary Pain (Rome IV)Rome IV — defining biliary-type pain before interventionFunctional Pancreatic SODRome IV — pancreatic sphincter of Oddi disorderRevised Atlanta ClassificationAcute pancreatitis severity — mild, moderately severe, severe

IBD

9
Truelove & Witts CriteriaAcute severe ulcerative colitis — admission decisionUCEISUlcerative colitis endoscopic index of severitySCCAISimple clinical colitis activity index — symptoms onlyCDAICrohn's disease activity index — the trial standardSES-CDEndoscopic severity in Crohn's diseasePUCAIPaediatric ulcerative colitis activity indexTravis (Oxford) CriteriaDay 3 colectomy risk in acute severe ulcerative colitisHo IndexDay 3 steroid failure risk in acute severe ulcerative colitisRutgeerts ScorePostoperative Crohn's recurrence at ileocolonoscopy

GI Bleeding

7
EVendo ScorePredicts oesophageal varices needing treatmentForrest ClassificationPeptic ulcer bleeding — rebleeding risk at endoscopyAIMS65 ScoreUpper GI bleed mortality — five bedside criteriaOakland ScoreSafe-discharge risk for acute lower GI bleedingABC ScoreAge, blood tests, comorbidities — GI bleed mortalitySarin ClassificationEndoscopic classification of gastric varicesEGUS (Gastric Ulcer)Malignancy risk in a gastric ulcer, and who needs repeat endoscopy

Alcohol

2
ABIC ScoreAge, bilirubin, INR, creatinine — alcoholic hepatitisLille ModelSteroid response at day 7 in alcoholic hepatitis

Upper GI

4
Chicago Classification v4.0Oesophageal motility pattern from high-resolution manometryLA Classification (Oesophagitis)Los Angeles grade A–D for erosive oesophagitisPrague C & M CriteriaCircumferential and maximal extent of Barrett's oesophagusEREFS (Eosinophilic Oesophagitis)Endoscopic reference score — oedema, rings, exudates, furrows, stricture

Colorectal

3
Boston Bowel Prep ScaleColonoscopy preparation adequacy by segmentStool Osmotic GapOsmotic vs secretory diarrhoea from stool electrolytesATLAS Score (C. difficile)Predicted response to therapy in Clostridioides difficile infection

Functional GI

37
Bristol Stool ScaleStool form types 1–7 and colonic transitRome IV Criteria for IBSIrritable bowel syndrome diagnosis and subtypeFunctional ConstipationRome IV — two of six items, IBS excludedOpioid-Induced ConstipationRome IV — constipation tied to opioid therapyFunctional DiarrhoeaRome IV — loose stools without predominant painFunctional Bloating / DistensionRome IV — bloating without other bowel disorder criteriaUnspecified Functional Bowel DisorderRome IV — bowel symptoms fitting no other categoryCentrally Mediated Abdominal Pain (CAPS)Rome IV — continuous pain unrelated to gut eventsNarcotic Bowel SyndromeRome IV — opioid-induced hyperalgesia of the gutFaecal Incontinence (Rome IV)Rome IV — the criteria, and why nobody is askedFunctional Anorectal PainLevator ani, unspecified pain and proctalgia fugaxFunctional Defecation DisordersRome IV — dyssynergia and inadequate propulsionInfant RegurgitationRome IV — the happy spitter, and the alarm features that rule it outInfant ColicRome IV — recurrent unexplained crying in a well infant under 5 monthsInfant DyscheziaRome IV — straining before a soft stool, and why not to intervenePaediatric Functional ConstipationRome IV — two of six over one month, with overflow soiling as a criterionToddler's DiarrhoeaRome IV functional diarrhoea of childhood — painless, thriving childPaediatric Cyclic Vomiting SyndromeRome IV — both age bands, with different criteria for eachPaediatric Rumination SyndromeRome IV — infant and child/adolescent criteriaFunctional Nausea & Vomiting (Children)Rome IV — two separate disorders that can be met togetherAerophagiaRome IV — distension that increases through the dayPaediatric Functional DyspepsiaRome IV — four times a month, with PDS and EPS subtypingPaediatric Irritable Bowel SyndromeRome IV — plus the constipation clause clinicians missAbdominal MigraineRome IV — stereotypical incapacitating episodes weeks apartFunctional Abdominal Pain — NOSRome IV — the residual category, reached after the other threeNonretentive Faecal IncontinenceRome IV — soiling without retention, where laxatives make it worseFunctional DyspepsiaRome IV — with PDS and EPS subtypingRumination SyndromeRome IV — effortless regurgitation without retchingCyclic Vomiting SyndromeRome IV — stereotypical episodic vomitingCannabinoid HyperemesisRome IV — CVS pattern relieved by cannabis cessationChronic Nausea & VomitingRome IV — chronic nausea and vomiting syndromeBelching DisordersRome IV — supragastric vs gastric belchingFunctional HeartburnRome IV — heartburn with normal acid exposureReflux HypersensitivityRome IV — normal acid exposure, positive symptom associationFunctional Chest PainRome IV — non-cardiac, non-reflux chest painGlobusRome IV — painless lump-in-throat sensationFunctional DysphagiaRome IV — dysphagia with normal endoscopy and manometry
  1. Calculators
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  3. Simplified AIH Criteria
Liver & Cirrhosis

Simplified AIH Criteria

Simplified criteria for autoimmune hepatitis

Maximum 2 points in total for ALL autoantibodies combined — they do not add up.

The 1.10 multiplier is the published figure; some secondary sources render it as 1.3.

Biopsy is effectively required — the maximum score without histology is 6, which reaches probable but never definite.

Worth 2 points, the same as a strongly positive autoantibody titre.

Four parameters, maximum 8 points. The autoantibody row is capped at 2 points however many antibodies are positive — a common way this score gets inflated.

When to use
Use it in routine practice when autoimmune hepatitis is suspected and you need a structured, reproducible diagnosis from the tests you already have. It was designed explicitly for the clinic rather than for research, which is why it uses four parameters instead of the thirteen in the revised original score. Reach for it first in a typical presentation; where it falls short of 6 but the clinical suspicion remains, the revised original score is the more sensitive instrument and is the right next step rather than a second opinion on the same evidence.
Why use it
Because the revised original IAIHG score is too long to use at the bedside and was never intended to be. It contains thirteen parameters including HLA typing and response to treatment, which suits case definition in a trial and not a clinic appointment. Hennes and colleagues asked which of those parameters were actually carrying the diagnostic weight, and found four: autoantibodies, IgG, histology and the exclusion of viral hepatitis. The resulting score fits on a single line of a clinic letter and achieves about 88% sensitivity with 97% specificity at the probable threshold — high enough specificity that a positive result is a confident diagnosis rather than a prompt to keep looking.
Formula, evidence and interpretation

About the Simplified Criteria for the Diagnosis of Autoimmune Hepatitis

Four parameters, maximum 8 points: autoantibodies (up to 2), serum IgG (up to 2), liver histology (up to 2) and exclusion of viral hepatitis (2). A score of 6 or above is probable autoimmune hepatitis and 7 or above is definite, with roughly 88% sensitivity and 97% specificity at the ≥6 cut-off. Two things catch people out. The autoantibody row is capped at 2 points however many antibodies are positive — they do not add up. And the maximum achievable without liver histology is 6, so a definite diagnosis is unreachable without a biopsy.

On this page

  • Formula
  • Interpreting the result
  • Inputs
  • What it returns
  • How it is calculated
  • Facts & figures
  • Evidence
  • How it compares
  • Pearls & pitfalls
  • Critical actions
  • Why it exists
  • About the creator
  • Limitations
  • If you are the patient
  • FAQ
  • Related calculators
  • References

Formula

Score = autoantibodies (0–2) + IgG (0–2) + histology (0–2) + absence of viral hepatitis (0 or 2) Maximum 8 · probable ≥ 6 · definite ≥ 7
Autoantibodies
ANA or SMA 1:40 → 1. ANA or SMA ≥ 1:80, or LKM-1 ≥ 1:40, or SLA/LP positive → 2. Capped at 2 in total.
IgG
> upper limit of normal → 1. > 1.10 × upper limit of normal → 2.
Histology
Compatible → 1. Typical → 2.
Absence of viral hepatitis
Excluded → 2. Present or not excluded → 0.
  • The autoantibody row is capped at 2 points regardless of how many antibodies are positive. A patient with a high-titre ANA, a positive SMA and a positive anti-SLA/LP scores 2, not 6 — this is the commonest way the score gets inflated.
  • Without liver histology the maximum is 6, which reaches probable but never definite. Biopsy is effectively required for a definite diagnosis.
  • Absence of viral hepatitis is worth 2 points, the same as the strongest autoantibody finding. That reflects how strongly the exclusion contributes, and it assumes the exclusion was actually done.
  • The IgG threshold for 2 points is 1.10 × the upper limit of normal in the published table. Some secondary reproductions state 1.3; the lower figure is the original.
  • A score below 6 does not exclude autoimmune hepatitis. The simplified criteria were built for specificity and miss atypical and seronegative presentations, where the revised original score performs better.

Interpreting the result

A score of 7 or 8 is a confident diagnosis. At the ≥6 threshold the criteria run around 88% sensitivity and 97% specificity, and specificity rises further at 7, so a definite result should be acted on rather than re-examined. A score of exactly 6 deserves a specific question: was a biopsy done? Because 6 is the ceiling without histology, a probable score in a patient who has not been biopsied may well become definite once tissue is available, and the biopsy also stages fibrosis and can reveal an alternative diagnosis. Below 6, the important point is what the result does not mean. The simplified criteria were optimised for specificity in routine practice and are known to miss atypical presentations, seronegative disease, and cases where anti-SLA/LP was never requested. A negative simplified score with persistent clinical suspicion is an indication to apply the revised original score, not to abandon the diagnosis.

ScoreBandWhat it meansAction
≥ 7Definite autoimmune hepatitisHigh specificity — around 97% at the ≥6 cut-off, rising further at 7Treat as autoimmune hepatitis; consider corticosteroids with or without azathioprine, weighing histological activity against comorbidity
6Probable autoimmune hepatitisMeets the probable threshold, with about 88% sensitivity and 97% specificity at this cut-offObtain histology if not already done — 6 is the ceiling without it, and a biopsy may move this to definite
< 6Criteria not metDoes not exclude autoimmune hepatitis — the simplified criteria miss atypical and seronegative presentationsApply the revised original IAIHG score, which is more sensitive; check that anti-SLA/LP was tested

What the Simplified AIH Criteria needs (4 inputs)

Autoantibodies
ANA or SMA at 1:40 scores 1. ANA or SMA at 1:80 or above, or anti-LKM-1 at 1:40 or above, or a positive anti-SLA/LP scores 2. The maximum for all autoantibodies combined is 2 — they do not accumulate.
Serum IgG
Above the upper limit of normal scores 1; above 1.10 times the upper limit scores 2. The 1.10 multiplier is the published figure, though a few secondary sources render it as 1.3.
Liver histology
Compatible with autoimmune hepatitis scores 1; typical of autoimmune hepatitis scores 2. Typical requires interface hepatitis, a lymphocytic or lymphoplasmacytic infiltrate extending into the lobule, and emperipolesis or hepatocellular rosetting.
Absence of viral hepatitis
Scores 2 — as much as a strongly positive autoantibody titre. This assumes viral hepatitis has actually been excluded by serology rather than merely considered unlikely.

What it returns

Total score
0 to 8. Probable autoimmune hepatitis at 6, definite at 7 or above.
Diagnostic category
Definite, probable, or criteria not met.
Item breakdown
Each parameter's contribution, which matters because the histology row is often the difference between probable and definite.

How it is calculated

The simplified criteria are a deliberate reduction of the revised original score rather than a new construct. Hennes and colleagues, working within the International Autoimmune Hepatitis Group, tested which of the original parameters retained independent diagnostic value and found the answer was four: autoantibodies, immunoglobulin G, liver histology and the exclusion of viral hepatitis. Each captures a different pillar of the diagnosis — the autoimmune serology, the humoral response, the tissue pattern, and the exclusion of the main mimic — which is why they are weighted almost equally at 2 points each rather than being fitted with regression coefficients. Capping the autoantibody row at 2 encodes a real clinical observation: multiple positive autoantibodies indicate autoimmunity, but a second or third positive antibody adds little diagnostic information beyond the first, so allowing them to accumulate would overstate the evidence.

Facts & figures

The scoring table
ParameterFindingPoints
AutoantibodiesANA or SMA at 1:401
ANA or SMA ≥ 1:80, or LKM-1 ≥ 1:40, or SLA/LP positive2
Serum IgG> upper limit of normal1
> 1.10 × upper limit of normal2
Liver histologyCompatible with AIH1
Typical of AIH2
Absence of viral hepatitisViral hepatitis excluded2

Maximum 8. The autoantibody rows are alternatives, not additions — the most that section can contribute is 2 points however many antibodies are positive.

Simplified versus revised original, side by side
Simplified (2008)Revised original (1999)
Parameters413, plus optional items
Maximum score8Around 25 depending on optional items
ThresholdsProbable ≥ 6, definite ≥ 7Pre-treatment: probable 10–15, definite > 15
Built forRoutine clinical practiceCase definition in research
Relative strengthSpecificity — about 97%Sensitivity, particularly in atypical cases
Needs histology?For a definite diagnosis, yesContributes heavily but the score functions without it

They are complements rather than competitors: the simplified score first, the revised original when the simplified score falls short but suspicion persists.

Evidence

Derivation — Hennes et al., International Autoimmune Hepatitis Group

2008

Development of simplified diagnostic criteria within the International Autoimmune Hepatitis Group, testing which parameters from the revised original score retained independent diagnostic value, and validating the resulting four-parameter score against clinical diagnosis.

At a cut-off of ≥6 the criteria achieved approximately 88% sensitivity and 97% specificity for autoimmune hepatitis, with ≥7 defining definite disease. Total possible score 8, with autoantibodies capped at 2 points.

AASLD practice guidance

2020

The 2019 AASLD practice guidance and guidelines on the diagnosis and management of autoimmune hepatitis in adults and children.

Endorses the simplified criteria for routine diagnosis while noting that the revised original score retains a role in atypical presentations and in research settings.

EASL clinical practice guidelines

2015

EASL clinical practice guidelines on autoimmune hepatitis.

Recommends the simplified criteria for clinical use, with the revised original score where the presentation does not fit the typical pattern.

Paediatric validation and modification

2012

Validation of the simplified criteria in children, where autoimmune sclerosing cholangitis overlaps clinically with autoimmune hepatitis.

Confirmed reasonable performance in children while showing reduced sensitivity in autoimmune sclerosing cholangitis, supporting modification and the use of cholangiography in paediatric presentations.

How it compares

Simplified AIH Criteria vs Revised original IAIHG score

Use the simplified score first and the revised original when it falls short — the first is more specific, the second more sensitive.

The revised original score has thirteen parameters plus optional items and was built for case definition in research; the simplified score has four and was built for the clinic. The trade is specificity for sensitivity. The revised original also contains terms the simplified score lacks entirely — notably a drug history penalty and an AMA penalty — which is why it performs better in atypical, seronegative and overlap presentations. Applying both is reasonable when the answer matters and they disagree.

Open the Revised original IAIHG score calculator →Hennes EM, Zeniya M, Czaja AJ, et al. Simplified criteria for the diagnosis of autoimmune hepatitis. Hepatology. 2008;48(1):169-176.

Simplified AIH Criteria vs RUCAM

Frequently needed together — drug-induced liver injury is the principal mimic of autoimmune hepatitis, and this score has no drug term at all.

A number of drugs, including nitrofurantoin, minocycline and infliximab, produce a syndrome indistinguishable from autoimmune hepatitis on serology and histology. The simplified criteria will happily score such a case at 7. RUCAM assesses whether a drug explains the injury, and a high RUCAM score in a patient who also meets AIH criteria is a strong argument for drug-induced liver injury with autoimmune features rather than for primary autoimmune hepatitis.

Open the RUCAM calculator →

Simplified AIH Criteria vs Child-Pugh score

Different questions entirely — this score diagnoses autoimmune hepatitis, Child-Pugh grades the severity of established cirrhosis.

The simplified criteria say nothing about severity, fibrosis stage or prognosis. A patient can score 8 with minimal fibrosis or with established cirrhosis. Once the diagnosis is made, staging comes from histology and from the usual liver severity measures.

Open the Child-Pugh score calculator →

Pearls & pitfalls

  • The autoantibody row caps at 2 points. Multiple positive antibodies do not accumulate, and treating them as additive is the commonest way this score is inflated.
  • The maximum without histology is 6. A definite diagnosis is unreachable without a biopsy, which is the practical argument for obtaining one.
  • Absence of viral hepatitis is worth 2 points and assumes the exclusion was actually performed with serology — not simply that viral hepatitis seemed unlikely.
  • Test anti-SLA/LP explicitly. It is highly specific for autoimmune hepatitis, worth a full 2 points, and frequently omitted from first-line autoimmune panels.
  • The IgG multiplier for 2 points is 1.10 × the upper limit of normal. A few secondary sources render this as 1.3; the published figure is the lower one.
  • 'Typical' histology is a specific bar — interface hepatitis, a lymphocytic or lymphoplasmacytic infiltrate extending into the lobule, and emperipolesis or rosetting. Anything less is 'compatible' at 1 point.
  • A score below 6 does not exclude the diagnosis. Move to the revised original score rather than dismissing the possibility.
  • Drug-induced liver injury mimics autoimmune hepatitis closely, including histologically and serologically, and this score has no term for drug exposure at all — the revised original score does.

Critical actions

  • Exclude viral hepatitis properly with serology before claiming the 2 points for its absence.
  • Obtain liver histology where the diagnosis is being made seriously — it is required for a definite score, stages fibrosis, and may reveal an alternative diagnosis.
  • Test the full autoantibody panel including anti-SLA/LP and anti-LKM-1, not only ANA and SMA.
  • Take a careful drug and supplement history; drug-induced liver injury is the principal mimic and is not represented in this score.
  • Where the score falls below 6 and suspicion persists, apply the revised original IAIHG score rather than stopping.
  • Consider overlap with primary biliary cholangitis or primary sclerosing cholangitis where the biochemistry is cholestatic, and arrange cholangiography in children and in adults with a cholestatic pattern.
  • Discuss corticosteroids with or without azathioprine once the diagnosis is established, weighing histological activity against comorbidity.

Why this score exists

The interesting decision is the cap on autoantibodies. Left uncapped, a patient with a high-titre ANA, a positive SMA and a positive anti-SLA/LP would score 6 on serology alone and reach probable autoimmune hepatitis without any histology or viral exclusion at all — which is exactly the false-positive the group wanted to avoid, because multiple autoantibodies are common in other liver diseases and in the elderly. Capping the row at 2 encodes the judgement that the second and third positive antibody add far less than the first. The same reasoning explains why exclusion of viral hepatitis is worth a full 2 points despite being a negative finding: in a patient with hepatitis and autoantibodies, ruling out the common cause is genuinely as informative as any positive test.

About the creator

  • Eva M. Hennes

    First author, 2008 simplified criteria

    Led the derivation of the simplified criteria within the International Autoimmune Hepatitis Group.

  • Albert J. Czaja

    Co-author; long-standing contributor to autoimmune hepatitis diagnostic criteria

    Co-authored both the revised original and the simplified criteria.

  • Michael P. Manns

    Senior author

    Senior author of the simplified criteria and a principal figure in the International Autoimmune Hepatitis Group.

Limitations

  • Built for specificity, so it misses atypical presentations — seronegative autoimmune hepatitis, acute severe presentations and overlap syndromes are all under-detected.
  • Contains no term for drug exposure, despite drug-induced liver injury being the principal mimic and being scored explicitly in the revised original criteria.
  • Requires liver histology for a definite diagnosis, which is not always obtainable in coagulopathic or acutely unwell patients.
  • 'Compatible' versus 'typical' histology is a pathologist's judgement, and interobserver agreement on that distinction is imperfect.
  • Reduced sensitivity in children, particularly where autoimmune sclerosing cholangitis is present, which cholangiography rather than this score identifies.
  • The exclusion of viral hepatitis is worth 2 points but the criteria do not specify which viruses or which tests, leaving the most heavily weighted negative finding loosely defined.
  • Derived predominantly in adult populations with typical presentations, which is the group in which any diagnostic score performs best.

If you are the patient

Autoimmune hepatitis is a condition where the immune system attacks the liver. There is no single test that proves it, so doctors add up evidence from four areas: certain antibodies in the blood, the level of an immune protein called IgG, what a liver biopsy shows, and confirmation that viral hepatitis is not the cause. Each area contributes up to 2 points, giving a maximum of 8. Six points means autoimmune hepatitis is probable and seven or more means it is considered definite. One practical point worth knowing: without a liver biopsy the highest possible score is six, so a biopsy is usually needed to be certain — and it also shows how much scarring there is, which affects treatment. If the score comes out below six but the doctors still suspect the condition, there is a longer and more detailed scoring system they can use instead, which picks up unusual presentations this shorter one can miss.

Frequently asked questions

What are the simplified criteria for autoimmune hepatitis?#

A four-parameter score: autoantibodies (up to 2 points), serum IgG (up to 2), liver histology (up to 2) and exclusion of viral hepatitis (2). Maximum 8. A score of 6 or above is probable autoimmune hepatitis and 7 or above is definite.

What score confirms autoimmune hepatitis?#

Seven or above is definite; six is probable. At the ≥6 cut-off the criteria have roughly 88% sensitivity and 97% specificity, and specificity rises further at 7.

Do multiple positive autoantibodies add up?#

No. The autoantibody section is capped at 2 points however many antibodies are positive. A patient with a high-titre ANA, a positive SMA and a positive anti-SLA/LP scores 2 for that section, not 6. Treating them as additive is the commonest error with this score.

Is a liver biopsy required?#

For a definite diagnosis, effectively yes. The maximum achievable without histology is 6, which reaches probable but never definite. A biopsy also stages fibrosis and can reveal an alternative diagnosis, so it is worth obtaining where the diagnosis matters.

Is the IgG threshold 1.10 or 1.3 times the upper limit of normal?#

The published figure in the 2008 criteria is 1.10 times the upper limit of normal for 2 points, with any elevation above the upper limit scoring 1. A small number of secondary reproductions state 1.3; the original is the lower value.

What if the score is below 6 but I still suspect autoimmune hepatitis?#

A negative simplified score does not exclude the diagnosis. Apply the revised original IAIHG score, which is more sensitive in atypical, seronegative and overlap presentations, and check that anti-SLA/LP was actually tested — it is highly specific and frequently omitted.

Can drug-induced liver injury score highly on these criteria?#

Yes, and this is a real weakness. Several drugs produce a syndrome indistinguishable from autoimmune hepatitis on serology and histology, and the simplified criteria contain no term for drug exposure at all. Take a careful drug and supplement history, and consider RUCAM alongside.

Do the simplified criteria work in children?#

They perform reasonably but with reduced sensitivity, particularly where autoimmune sclerosing cholangitis is present — which is common in paediatric autoimmune liver disease and is identified by cholangiography rather than by this score.

Related calculators

  • Revised Original AIH Score — IAIHG 1999 comprehensive autoimmune hepatitis score
  • RUCAM — Causality in drug- and herb-induced liver injury
  • R Factor — Hepatocellular vs cholestatic pattern in liver injury
  • Child-Pugh Score — Assesses the prognosis of chronic liver disease, mainly cirrhosis
  • FIB-4 Index — Liver fibrosis scoring index
  • MELD-Na — Assesses the severity of chronic liver disease

References

Original / primary reference

  1. Hennes EM, Zeniya M, Czaja AJ, et al. Simplified criteria for the diagnosis of autoimmune hepatitis. Hepatology. 2008;48(1):169-176.

Guidelines

  1. Mack CL, Adams D, Assis DN, et al. Diagnosis and Management of Autoimmune Hepatitis in Adults and Children: 2019 Practice Guidance and Guidelines from the American Association for the Study of Liver Diseases. Hepatology. 2020;72(2):671-722.
  2. European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Autoimmune hepatitis. J Hepatol. 2015;63(4):971-1004.
  3. Alvarez F, Berg PA, Bianchi FB, et al. International Autoimmune Hepatitis Group Report: review of criteria for diagnosis of autoimmune hepatitis. J Hepatol. 1999;31(5):929-938.

Last updated August 1, 2026. Clinical knowledge base written and curated by GastroAGI Team from primary medical literature.

Written from primary literature and not yet independently clinically reviewed.

For use by qualified healthcare professionals. This calculator supports clinical judgement and does not replace it.