Liver Injury Pattern and Hy's Law
Enter the first abnormal values. The tool gives the R ratio, the injury pattern, the RUCAM worksheet to use, and whether Hy's Law criteria are met.
Definitions
| Item | Definition |
|---|---|
| R ratio | (ALT ÷ ULN) ÷ (ALP ÷ ULN), from values measured when liver injury is suspected. |
| Hepatocellular | ALT > 5 × ULN with ALP ≤ ULN, or both raised with R ≥ 5. |
| Cholestatic | ALP > 2 × ULN with ALT ≤ ULN, or both raised with R ≤ 2. |
| Mixed | ALT > 5 × ULN and ALP > ULN with 2 < R < 5. |
| RUCAM threshold | ALT at least 5 × ULN and/or ALP at least 2 × ULN. |
| Hy's Law | ALT > 3 × ULN with total bilirubin > 2 × ULN, in the absence of biliary obstruction. About 10% of such patients die or need a transplant (book, Chapter 2). |