Hematology and Oncology · Gastroenterology
Immune-Related Hepatitis Grade calculator
Enter the published formula inputs below to calculate and interpret this score.
Clinical inputs
Allowed range: 0–100 × ULN
Divide the result by that laboratory's upper limit of normal. The transaminase grade uses AST or ALT, whichever multiple is higher. A value of 1 is at the upper limit and is not above it.
Allowed range: 0–100 × ULN
Divide the result by that laboratory's upper limit of normal. The transaminase grade uses AST or ALT, whichever multiple is higher. A value of 1 is at the upper limit and is not above it.
Allowed range: 0–50 × ULN
Divide the result by that laboratory's upper limit of normal. The transaminase grade uses AST or ALT, whichever multiple is higher. A value of 1 is at the upper limit and is not above it.
Result
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Clinical inputs
- AST, multiple of the upper limit (× ULN)Accepted range: 0 to 100
- ALT, multiple of the upper limit (× ULN)Accepted range: 0 to 100
- Total bilirubin, multiple of the upper limit (× ULN)Accepted range: 0 to 50
- Symptomatic liver dysfunction
- Fibrosis on biopsy
- Compensated cirrhosis
- Reactivation of chronic hepatitis
- Decompensated liver function
Primary source
Brahmer JR et al. Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol. PMID: 29442540. Table 2.2. Grade 1: AST or ALT > ULN to 3.0 × ULN and/or total bilirubin > ULN to 1.5 × ULN. Grade 2: AST or ALT > 3.0 to ≤ 5 × ULN and/or total bilirubin > 1.5 to ≤ 3 × ULN. Grade 3: symptomatic liver dysfunction, fibrosis by biopsy, compensated cirrhosis, reactivation of chronic hepatitis, AST or ALT 5–20 × ULN, and/or total bilirubin 3–10 × ULN. Grade 4: decompensated liver function (ascites, coagulopathy, encephalopathy, or coma), AST or ALT > 20 × ULN, and/or total bilirubin > 10 × ULN. The transaminase grade uses the higher of AST and ALT. Exactly 5 × ULN and exactly 3 × bilirubin meet both the grade 2 upper bound and the grade 3 range, so grade 3 is returned. Exactly 20 × ULN and exactly 10 × bilirubin stay grade 3 because grade 4 requires a value above those bounds. Management text from the table is not used. (2018)
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