Diagnostic criteria for autoimmune hepatitis in children: A challenge for pediatric hepatologists

Table 1 Summary of pediatric studies on the validation of diagnostic criteria for autoimmune hepatitis

Authors	Place and date	n	Diagnostics	Tested criteria	Results	Conclusions
Mileti et al[1]	United States, 2012	68	37 AIH for 1999 criteria/ 31 AIH for 2008 criteria 40 non-AIH	1999 and 2008	1999 criteria: 29 of 31 subjects (94%) as definite AIH; 2 of 31 subjects (6%) as probable AIH Simplified criteria: 25 of 31 subjects (81%) as definite AIH; 2 of 31 subjects (6%) as probable AIH The 2008 diagnostic criteria had a sensitivity of 87% and a specificity of 89% and did not identify 4 patients with AIH and fulminant hepatic failure	The 2008 criteria showed high levels of sensibility and specificity Patients with fulminant hepatic failure need the 1999 criteria Globulin and immunoglobulin G can be used interchangeably
Ebbeson et al[10]	Canada, 2004	28	21 AIH 4 PSC 3 ASC	1999	18 of 21 (86%) with AIH scored as definite AIH and 3 of 21 (14%) scored as probable All patients with isolated PSC scored as not AIH	The IAIHG scoring system has a use in children Using the GGT ratio may improve the specificity for children
Hiejima et al[11]	Japan, 2011	56	20 AIH 36 non-AIH liver diseases	1999 and 2008	Sensitivity and specificity of the 1999 criteria were 100% and 81%, respectively Sensitivity and specificity of the simplified criteria were 55% and 86%, respectively All 5 children with PSC were graded as having AIH by both criteria	The specificity of the simplified AIH criteria is high Simplified criteria could not differentiate between AIH and PSC and do not seem to be a reliable diagnostic tool in children

AIH: Autoimmune hepatitis; PSC: Primary sclerosing cholangitis; ASC: Autoimmune sclerosing cholangitis; IAIHG: International autoimmune hepatitis group; GGT: Gamma-glutamyl transferase.