This Alchemist Lab formula, developed by Dr. Steven Finkbine as part of his doctoral program, is based on commonly performed blood tests as well as age — and generates one number that corresponds to the stage of liver damage.

Take the **AST** and add 5 zeros to it. Divide the **ALT** into the **AST**. Then divide that number by the Platelets. Add the age.

Add or subtract the Albumin from a midpoint of 4.3. For anything above 4.3 subtract 10 points, for each 0.1 below 4.3 add 10 points. So an Albumin of 4.8 would subtract 50 points, an Albumin of 3.7 would add 60 points.

For Bilirubin add or subtract from a midpoint of 0.7, with a value of 5 points for each 0.1 deviation. So for a Bilirubin of 1.2 add in 25 points. For a Bilirubin of 0.4 you would subtract 15 points.

Add or subtract **AST** from a midpoint of 45. If the **AST** is 89 add 44, if the **AST** is 23, subtract 22. For cases that the **AST/ALT** ratio is under 0.5 and the **AST** is 90 or over, instead of adding or subtracting the **AST**, add the **AST** with 90 as the base. For example if the **AST** is 58 and the **ALT** is 299 the **AST/ALT** ratio is 0.19 which is under 0.5. You would add in 209 points. This balances the cases that a very high **ALT** number proportionate to **AST** would otherwise skew.

**––––––––––––––– SAMPLE CASE –––––––––––––––**

**AST 56 // ALT 89 // Platelets 188 // Albumin 4.4 // Bilirubin 0.6 // Age 46**

**5600000** **divided by 89 = 62,921 divided by 188 = 335**

**Add in 46 for age. ****Subtract 10 for Albumin. Subtract 5 for Bilirubin.**

**Add in 11 for AST for a total of 377. ****This score is borderline Stage 1.5 / 2**

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Stage 4 is Cirrhosis. Stage 5 is decompensated Cirrhosis. In the initial study of 45 patients this scale deviated from the biopsy stage by 0.611 of a stage.

Any feedback will be appreciated to further refine this scale. At this point the deviations have run 52.7% higher and 47.3% lower than the biopsy score.

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