A focused collection of 17 calculators, scores, and clinical references.
APRI (AST to Platelet Ratio Index): Explanation and Clinical Context The APRI score is a non-invasive index to predict the presence of liver fibrosis and cirrhosis, originally validated in patients with chronic hepatitis C. It is calculated using the formula: [(AST / Upper Limit of Normal AST) / Platelet Count (10^9/L)] × 100. Lower values (<0.5) indicate minimal or no fibrosis, intermediate values (0.5–1.5) suggest
AST/ALT Ratio (De Ritis Ratio): Explanation and Clinical Context The AST/ALT ratio, also known as the De Ritis ratio, is a simple but valuable biomarker used in the assessment of liver injury and prognosis. It was first described by Fernando De Ritis in 1957 as the ratio between serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT). A ratio less than 1 typically indicates acute hepatocellular inju
Bilirubin/Albumin Ratio (BAR Index): Explanation and Clinical Context The Bilirubin/Albumin Ratio (BAR) is a biochemical marker that reflects the balance between liver excretory function (represented by serum bilirubin) and synthetic capacity (represented by albumin). An elevated BAR value indicates an imbalance between hepatocellular injury and decreased albumin synthesis, both of which are associated with systemic
Cardiac Hepatopathy Severity Index (CHSI) — Explanation and Clinical Context This page implements a proposed, research-use-only Cardiac Hepatopathy Severity Index (CHSI): a transparent composite designed to summarize liver injury/functional impairment and chronic fibrosis surrogates commonly observed in congestive hepatopathy (cardiac hepatopathy). Because no single, widely-adopted numerical 'CHSI' exists in the lite
Cardiohepatic Index (Hepato-renal Risk Composite): Explanation and Clinical Context The Cardiohepatic Index (CHI) is a composite biomarker integrating hepatic and renal dysfunction to predict adverse outcomes in patients with advanced heart failure. It is calculated using serum bilirubin, creatinine, and sodium levels, reflecting the interplay between hepatic congestion, renal impairment, and systemic hemodynamics. E
Child–Turcotte–Pugh (CTP / Child–Pugh) score — explanation and references The Child–Pugh score is a 5-item clinical scoring system originally developed to estimate prognosis in chronic liver disease and cirrhosis and to guide surgical risk assessment. Each of five parameters (total bilirubin, serum albumin, coagulation — expressed as INR or PT prolongation — ascites, and hepatic encephalopathy) is scored 1–3 points a
Congestive Hepatic Fibrosis Score (CHFS): explanation and clinical context The CHFS is a histology-based grading system that stages fibrosis patterns seen in congestive hepatopathy on liver biopsy — it ranges from 0 (no fibrosis) through 4 (cirrhosis), with intermediate grades that distinguish centrizonal-limited fibrosis (stage 1), combined centrizonal and portal patterns with differing zone predominance (2A and 2B)
FIB-4 in Cardiac Cirrhosis: Explanation and Clinical Context FIB-4 is a non-invasive scoring system originally validated for assessing liver fibrosis in patients with chronic liver disease and has been adapted for cardiac cirrhosis to estimate fibrosis severity. It uses age, AST (aspartate aminotransferase), ALT (alanine aminotransferase), and platelet count as variables. Lower scores (<1.45) indicate low risk of adv
Hepatic Congestion Grading (Echo Doppler based): Explanation and Clinical Context Hepatic congestion grading uses Doppler assessment of hepatic vein flow (S wave / D wave ratio) and inferior vena cava (IVC) diameter to quantify venous congestion. The S/D ratio reflects right atrial pressure and hepatic venous compliance, while IVC diameter indicates systemic venous overload. Grade 0 (no congestion) is indicated by no
Liver Function Recovery Index (LFRI) Post-VAD: Explanation and Clinical Context The Liver Function Recovery Index (LFRI) is a predictive tool used to estimate the likelihood of hepatic recovery in patients after ventricular assist device (VAD) implantation. It incorporates pre-VAD biochemical markers including total bilirubin, AST, ALT, and INR to quantify liver dysfunction severity and potential for post-operative r
Liver Stiffness Index (Elastography, Cardiovascular Implications): Explanation and Clinical Context Liver stiffness, measured by transient elastography, is a non-invasive marker of liver fibrosis. Elevated liver stiffness is not only associated with progression of chronic liver disease but also with increased cardiovascular risk. Multiple studies have shown that higher liver stiffness values correlate with subclinica
MELD (Model for End-stage Liver Disease): Explanation and clinical context The MELD score is an objective, laboratory-based model developed to predict short-term mortality in patients with advanced liver disease and to assist in prioritizing liver transplant allocation. The original formula (Kamath/Wiesner et al.) uses three laboratory inputs — serum total bilirubin (mg/dL), international normalized ratio (INR), and
MELD-HF Score (Transplant Candidacy): Explanation and Clinical Context The MELD-HF Score is a modified version of the original Model for End-stage Liver Disease (MELD) used to prioritize patients with advanced heart failure for transplant. It incorporates key laboratory parameters: serum creatinine, total bilirubin, INR, and serum sodium, reflecting renal function, hepatic function, coagulation status, and electrolyt
MELD-Lactate (for postoperative risk prediction): Explanation and clinical context The MELD-Lactate score was proposed to combine standard liver-failure predictors (the original MELD score, which uses bilirubin, INR and creatinine) with immediate postoperative lactate levels to improve early mortality prediction after major surgery. The original publication (Cardoso et al., Transplant Proceedings 2014) derived the fo
MELD-Na (Model for End-Stage Liver Disease including serum sodium): explanation and clinical context The MELD score is a widely validated, laboratory-based model to estimate short-term (90-day) mortality in patients with advanced liver disease; it uses serum bilirubin, INR, and serum creatinine as inputs. The MELD-Na score augments MELD by incorporating serum sodium as an independent predictor of mortality in cirrhos
MELD-XI (Model for End-Stage Liver Disease — excluding INR): Explanation and clinical context MELD-XI is a modification of the original MELD score intended to provide a prognostic measure of hepatorenal dysfunction when INR is unreliable (for example, in patients on anticoagulation). The commonly used formula is: MELD-XI = 5.11 × ln(total bilirubin [mg/dL]) + 11.76 × ln(serum creatinine [mg/dL]) + 9.44. To avoid math
Porto-Systemic Flow Ratio (PSFR): Explanation and Clinical Context The Porto-Systemic Flow Ratio (PSFR) quantifies the relative blood flow between the portal vein and the hepatic vein, reflecting the balance of portal and systemic circulation in patients with chronic liver disease and portal hypertension. A PSFR near 1 indicates a normal physiologic balance, whereas deviations may reflect shunting, hepatic congestion