Cardiac Hepatopathy Severity Index (CHSI) Calculator
Cardiac Hepatopathy Severity Index (CHSI) — Explanation and Clinical Context
This page implements a proposed, research-use-only Cardiac Hepatopathy Severity Index (CHSI): a transparent composite designed to summarize liver injury/functional impairment and chronic fibrosis surrogates commonly observed in congestive hepatopathy (cardiac hepatopathy). Because no single, widely-adopted numerical 'CHSI' exists in the literature, the calculator reports well-established component scores (MELD and FIB-4) and combines them with simple clinical features (ascites) and an optional hemodynamic proxy (estimated right atrial pressure, RAP) into a composite index. The principal intent is exploratory: researchers and clinicians can use the outputs to compare trajectories and to help design formal validation studies.
Definitions and rationale: MELD (Model for End-Stage Liver Disease) quantifies short-term mortality risk using bilirubin, creatinine and INR and is a robust measure of hepatic synthetic dysfunction and multi-organ interaction; therefore MELD is given the largest weight in the composite. FIB-4 is a noninvasive laboratory index that correlates with chronic fibrosis and is included as a surrogate for structural hepatic change. Ascites and elevated RAP are clinical/hemodynamic markers of congestion and portal hypertension/venous pressure, which are central to the pathophysiology of congestive hepatopathy.
Interpretation guidance (research use only): The composite CHSI returned is an index without formal diagnostic or therapeutic thresholds. Lower values are intended to indicate milder hepatic involvement; higher values indicate more advanced combined dysfunction/fibrosis/congestion. The page also returns MELD and FIB-4 (where calculable) so clinicians and investigators can interpret individual components.
Limitations and disclaimers: This composite is not validated. The weights and thresholds were chosen for transparency and face validity, not derived from a prospective dataset. Important histologic scoring systems for congestive hepatopathy (for example, the Congestive Hepatic Fibrosis Score) rely on liver biopsy patterns and cannot be fully captured by laboratory values alone. Use this tool only for education, exploratory research, or as a component of structured validation work.
References:
- Dao-Fu Dai et al., "Congestive hepatic fibrosis score: a novel histologic assessment of clinical severity" — description and validation of a histologic scoring system for congestive hepatopathy.
- Kamath PS et al. / MELD literature — MELD formula and its clinical use (bilirubin, creatinine, INR).
- Review articles on congestive hepatopathy: pathophysiology and clinical correlations (passive congestion, hepatic synthetic dysfunction and prognostic importance).