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Scoring and Staging Hepatitis C
Scoring Systems for Staging of Chronic Hepatitis
Various scoring systems are used to evaluate the amount of fibrosis in chronic hepatitis.
Score Description Knodel Sciot and Desmet (unpublished) Scheuer
0 No fibrosis No fibrosis None None
1 Mild fibrosis Fibrous portal expansion Periportal fibrous expansion Enlarged,fibrotic portal tracts
2 Moderate fibrosis   Porto-portal septa
(> 1 septum)
Periportal or portal-portal septa, but intact architecture
3 Severe fibrosis Bridging fibrosis
(portal-portal or portal-central linkage)
Portocentral septa
(> 1 septum)
Fibrosis with architectural distortion, but no obvious cirrhosis
4 Cirrhosis Cirrhosis Cirrhosis Probable or definite cirrhosis

From: Desmet: Hepatology:(1994) 19:1513; Knodell: Hepatology:(1981) 1:431; Scheuer: J Hepatology:(1991) 13:372

HAI (histological activity index) by Knodell

    I. Periportal +/- Bridging Necrosis [Score]
      A. none [ 0]
      B. mild piecemeal necrosis [1]

      C. moderate piecemeal necrosis (involve less than 50% of the circumference of most portal tracts) [3]

      D. marked piecemeal necrosis (involve more athan 50% of the circumference of most portal tracts) [4]

      E. moderate piecemeal necrosis plus bridging necrosis plus bridging necrosis [5]

      F. marked piecemeal necrosis plus bridging necrosis plus bridging necrosis [6]

      G. multilobular necrosis [10]
    II. Intralobular Degeneration and Focal Necrosis
      A. none [0]
      B. mild (acidoplhilic bodies, balooning degeneration and/or scattered foci of hepatocellular necrosis in < 1/3 of lobules or nodules) [1]

      C. moderate (involvement of 1/3 ~ 2/3 of lobules or nodules) [3]

      D. marked (involvement of > 2/3 of lobules or nodules) [4]
    III. Portal Inflammation
      A. no portal inflammation [0]
      B. mild (sprinkling of inflammatory cells in < 1/3 of portal tracts) [1]

      C. moderate (increased inflammatory cells in 1/3 ~ 2/3 of portal tracts) [3]

      D. marked (dense packing of inflammatory cells in > 2/3 of portal tracts) [4]
    IV. Fibrosis
      A. no fibrosis [0]
      B. fibrous portal expansion [1]

      C. bridging fibrosis (portal-portal or portal-central linkage) [3]

      D. cirrhosis [4]

From Knodell RG et al.; Formulation and application of a numerical scoring system for assessing histological activity in asymtomatic chronic active hepatitis. Hepatology, (1981) 1:431

Grading system for cirrhosis: the Child-Pugh score
Score Bilirubin
PT (Sec) Hepatic
1 < 2 > 3.5 1 - 4 None None
2 2 - 3 2.8 - 3.5 4 - 6 1 - 2 Mild
3 > 3 < 2.8 > 6 3 - 4 Severe

Child class: A= 5 - 6, B= 7 - 9, C= > 9



    Page last updated: March 7, 2003

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