Healthcare & Clinical
Glasgow Alcoholic Hepatitis Score (GAHS) Calculator (5–12 Points)
Compute Ewan Forrest’s Glasgow Alcoholic Hepatitis Score (GAHS, 5–12 points) from age, WBC, blood urea, PT ratio / INR, and serum bilirubin to identify high-mortality patients (GAHS >= 9) who benefit from corticosteroids.
Why GAHS >= 9 sharpens specificity when Maddrey mDF >= 32 over-treats moderate alcoholic hepatitis!
Maddrey’s Discriminant Function (mDF >= 32) is highly sensitive but has modest specificity, exposing some surviving patients to steroid infection risk. Ewan H. Forrest et al. (Gut, 2005) derived and validated the 5-to-12 point Glasgow Alcoholic Hepatitis Score (GAHS) using five routinely measured SI variables: Age (< 50 yr = 1, >= 50 = 2), Leukocyte count WBC (< 15 × 10^9/L = 1, >= 15 = 2), Urea (< 5.0 mmol/L [BUN < 14 mg/dL] = 1, >= 5.0 = 2), PT ratio or INR (< 1.5 = 1, 1.5–2.0 = 2, > 2.0 = 3), and Serum Bilirubin (< 125 μmol/L [7.3 mg/dL] = 1, 125–250 = 2, > 250 [14.6 mg/dL] = 3)!
In UK multicenter validation, patients with mDF >= 32 had 84-day survival of 78% when GAHS < 9 (showing NO survival gain from steroids), whereas GAHS >= 9 carried dismal untreated 84-day survival of just 41%—jumping to 59% with prednisolone therapy!
| GAHS Variable | 1 Point | 2 Points | 3 Points |
|---|---|---|---|
| Age (yr) / WBC (× 10^9/L) / Urea (mmol/L) | < 50 / < 15 / < 5.0 | >= 50 / >= 15 / >= 5.0 | — (Max 2 pts each) |
| PT Ratio or INR | < 1.5 | 1.5 – 2.0 | > 2.0 |
| Total Bilirubin (μmol/L) | < 125 (< 7.3 mg/dL) | 125 – 250 | > 250 (> 14.6 mg/dL) |
Glasgow Alcoholic Hepatitis Score (GAHS, 5 to 12 Points)
Sums 1–2 or 1–3 point subscores across Age B2 (yr), WBC B3 (× 10^9/L), Urea B4 (mmol/L), INR / PT ratio B5, and Bilirubin B6 (μmol/L).
=IF(OR(B2 < 18, B3 <= 0, B4 < 0, B5 <= 0, B6 < 0), "Invalid GAHS Labs", IF(B2 >= 50, 2, 1) + IF(B3 >= 15, 2, 1) + IF(B4 >= 5, 2, 1) + IF(B5 > 2, 3, IF(B5 >= 1.5, 2, 1)) + IF(B6 > 250, 3, IF(B6 >= 125, 2, 1)))GAHS >= 9 Poor-Prognosis & Steroid-Benefit Threshold
Stratifies 28- and 84-day mortality risk around the validated GAHS >= 9 threshold.
=IF(OR(B2 < 18, B3 <= 0, B4 < 0, B5 <= 0, B6 < 0), "Invalid GAHS Labs", IF(IF(B2 >= 50, 2, 1) + IF(B3 >= 15, 2, 1) + IF(B4 >= 5, 2, 1) + IF(B5 > 2, 3, IF(B5 >= 1.5, 2, 1)) + IF(B6 > 250, 3, IF(B6 >= 125, 2, 1)) >= 9, "High Mortality (GAHS >= 9 — Steroid Benefit)", "Favorable Prognosis (GAHS 5-8 — Supportive Care)"))Try the example
Use the original values or change them to test your understanding.