RUCAM Calculator (2016 update)

The updated Roussel Uclaf Causality Assessment Method for suspected drug- or herb-induced liver injury. Complete it separately for each suspected product.

0.Which worksheet?Use R = (ALT / ULN) ÷ (ALP / ULN) at the time liver injury is suspected. R ≥ 5 is hepatocellular; R ≤ 2 is cholestatic; 2 < R < 5 is mixed. Cholestatic and mixed injury share one worksheet.

ALT (U/L) ALT upper limit (U/L) ALP (U/L) ALP upper limit (U/L)

Hepatocellular Cholestatic or mixed

How the total is read

Total score	Causality
9 or more	Highly probable
6 to 8	Probable
3 to 5	Possible
1 to 2	Unlikely
0 or less	Excluded

RUCAM applies to acute liver injury, defined as ALT at least 5 × ULN and/or ALP at least 2 × ULN. It is not for pre-existing chronic liver disease, for intrinsic (dose-dependent) toxicity, or when ALP is raised for non-hepatic reasons. Scores run from −9 to +14 (Danan & Teschke 2016, Table 1 and section 5). Table 2 of the paper prints the ultrasound item twice in Group I; the HBV item is taken from the matching position in Table 3.