Grading & Scoring Liver Damage

Knodell Histological Activity Index

1. Periportal +/-bridging necrosis [Score]
   1. none [ 0]
   2. mild piecemeal necrosis [1]
   3. moderate piecemeal necrosis (involve less than 50% of the circumference of most portal tracts) [3]
   4. marked piecemeal necrosis (involve more athan 50% of the circumference of most portal tracts) [4]
   5. moderate piecemeal necrosis plus bridging necrosis plus bridging necrosis [5]
   6. marked piecemeal necrosis plus bridging necrosis plus bridging necrosis [6]
   7. multilobular necrosis [10]
2. intralobular degeneration and focal necrosis
   1. none [0]
   2. mild (acidoplhilic bodies, balooning degeneration and/or scattered foci of hepatocellular necrosis in less than 1/3 of lobules or nodules) [1]
   3. moderate (involvement of 1/3 ~ 2/3 of lobules or nodules) [3]
   4. marked (involvement of > 2/3 of lobules or nodules) [4]
3. portal inflammation
   1. no portal inflammation [0]
   2. mild (sprinkling of inflammatory cells in less than 1/3 of portal tracts) [1]
   3. moderate (increased inflammatory cells in 1/3 ~ 2/3 of portal tracts) [3]
   4. marked (dense packing of inflammatory cells in > 2/3 of portal tracts) [4]
4. fibrosis
   1. no fibrosis [0]
   2. fibrous portal expansion [1]
   3. bridging fibrosis (portal-portal or portal-central linkage) [3]
   4. cirrhosis [4]