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Glasgow alcoholic hepatitis score – GAHS [Explained]

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Glasgow alcoholic hepatitis score (GAHS)

Forrest E H, et al.1  identified 241 patients with alcoholic hepatitis and recorded clinical and laboratory data on admission (day 1) and on days 6 through 9 with the goal of determining which variables were strongly correlated with outcome at 28 and 84 days after admission.   At the completion of the study, the GAHS score on day 1 had  an overall accuracy of 81% when predicting 28 day outcome, while the modified discriminant function had an overall accuracy of 49%.  The GAHS was similarly effective using information at days 6 to 9 when predicting 84 day outcome.
Age (years):
<50
>/= 50

WBC: 
<15  (109/L  or 103/µL)
15 or greater  (109/L  or 103/µL)

Urea:
<5 (umol/L)   or  <14 (mg/dL)
5 or greater (umol/L)   or  14 or greater (mg/dL)

PT ratio:
<1.5
1.5 - 2.0
>2

Bilirubin:
125 (µmol/L)  or  <7.3 (mg/dL)
125 - 250 (µmol/L)  or  7.3 - 14.6 (mg/dL)
>250   (µmol/L)  or  >14.6 (mg/dL)

Background Info
Glasgow Alcoholic Hepatitis Score (GAHS):



Range: 5 to 12.   There is a marked rise in mortality when the score is greater than or equal to 9.


Scoring:
SI units Score
Parameter: 1 2 3
Age <50 >/=50 -
WBC <15 >/=15  
Urea (mmol/L) 5 >/=5  
PT ratio <1.5 1.5-2 >2
Bilirubin (µmol/l) <125 125-250 >250
 

Conventional units Score
Parameter: 1 2 3
Age <50 >/=50 -
WBC 109/L <15 >/=15  
Urea (mg/dL) 14 >/=14  
PT ratio <1.5 1.5-2 >2
Bilirubin (mg/dL) <7.3 7.3-14.6 >14.6

Survival from alcoholic hepatitis with respect to individual Glasgow alcoholic hepatitis score (GAHS) values1.

Day 1 score:
Less than 9:
Day 28 survival (%):  87
Day 84 survival (%):  79

Greater than or equal to 9:
Day 28 survival (%):  46
Day 84 survival (%):  40

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Day 6 to 9 score:
Less than 9:
Day 28 survival (%):  93
Day 84 survival (%):  86

Greater than or equal to 9:
Day 28 survival (%):  47
Day 84 survival (%):  37

References
Forrest E H, Evans C D J, Stewart S. et al Analysis of factors related to mortality in alcoholic hepatitis and the derivation and validation of the Glasgow alcoholic hepatitis score. Gut 2005; 54; 1174-1179.    [PubMed]
Glasgow alcoholic hepatitis score – GAHS