{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:47:33Z","timestamp":1789001253974,"version":"build-2803163510"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2018,2,20]],"date-time":"2018-02-20T00:00:00Z","timestamp":1519084800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Hepatology Communications"],"published-print":{"date-parts":[[2018,3]]},"abstract":"<jats:p>\n                    Autoimmune hepatitis (AIH) and primary biliary cholangitis (PBC) are two major immune\u2010mediated chronic liver diseases. Overlap syndrome (OS) is diagnosed if patients have features of both AIH and PBC; however, there is no consensus on the definition or diagnostic criteria for OS. Here, we report a new scoring classification for OS and evaluate its usefulness. This new scoring classification was developed by modifying the International Autoimmune Hepatitis Group classification by selecting histologic features of AIH and PBC along with modifications of biochemical and immunologic characteristics. We evaluated 272 patients with chronic liver disease, including 105 with AIH, 102 with PBC, and 65 with OS. The best performance for the diagnosis of OS was noted among patients with an overlap score of \u226521 who had a sensitivity of 98.5%, a specificity of 92.8%, a positive predictive value of 81.0%, and a negative predictive value of 99.5%. By using a cut\u2010off score of 21, 64 (98.5%) patients were diagnosed with OS as opposed to 9 (8.8%) and 6 (5.7%) with PBC and AIH, respectively. All patients with OS had an aggregate score of &gt;19, whereas most patients with PBC or AIH scored &lt;19, making this a safe discriminatory cut\u2010off point against OS.\n                    <jats:italic toggle=\"yes\">Conclusion<\/jats:italic>\n                    : The new scoring system for the diagnosis of OS has a high sensitivity and specificity for scores \u226521, while a score &lt;19 suggests a diagnosis other than OS. This classification can identify patients and diagnose OS with a reasonable amount of accuracy and may be superior to current OS scoring systems in detecting mild forms of OS. 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Louis,MO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kahee A.","family":"Mohammed","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine,Saint Louis University School of Medicine,St Louis,MO"},{"name":"Saint Louis University Center for Outcomes Research,St. Louis,MO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satish","family":"Munigala","sequence":"additional","affiliation":[{"name":"Saint Louis University Center for Outcomes Research,St. Louis,MO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guilan","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Pathology,Saint Louis University School of Medicine,St. Louis,MO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin\u2010Ping","family":"Lai","sequence":"additional","affiliation":[{"name":"Department of Pathology,Saint Louis University School of Medicine,St. Louis,MO"},{"name":"Department of Pathology, Immunology, and Laboratory Medicine,University of Florida, College of Medicine,Gainesville,FL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruce R.","family":"Bacon","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology,Saint Louis University School of Medicine,St Louis,MO"},{"name":"Saint Louis University Liver Center,St Louis,MO"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2018,2,20]]},"reference":[{"key":"hep41148-bib-0001-20240114","doi-asserted-by":"crossref","first-page":"1261","DOI":"10.1056\/NEJMra043898","article-title":"Primary biliary cirrhosis","volume":"353","year":"2005","journal-title":"N Engl J Med"},{"key":"hep41148-bib-0002-20240114","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1056\/NEJMra050408","article-title":"Autoimmune hepatitis","volume":"354","year":"2006","journal-title":"N Engl J 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