Diagnostic value of serum bile acids and routine liver function tests in hepatobiliary diseases

Abstract

Total serum bile acids measured by enzymatic fluorometry and routine liver function tests were determined in a large population including 97 healthy subjects, 138 patients free of hepatobiliary diseases but affected by other diseases, and 344 patients with mild or severe hepatobiliary diseases. In order to define the diagnostic value and some operational characteristics of serum bile acids, sensitivity, specificity, and several predictive value tables for increasing cutoff levels of serum bile acids were calculated by means of a computer program. Serum bile acids and aspartate aminotransferase were found to be similar in sensitivity, specificity, and predictive value. Serum aspartate aminotransferase was found to be more suitable than serum bile acids in detecting mild hepatobiliary diseases, whereas serum bile acids were more sensitive than routine liver tests in the evaluation of severe hepatobiliary diseases. In view of its ability to detect severe hepatobiliary diseases, serum bile acids test may play a decisive role in clinical practice (eg, decision to perform a liver biopsy).

Serum Enzymes and Enzyme Profiles in the Diagnosis of Liver and Biliary Tract Disease

“…AST and ALT are the most sensitive bio chemical indices of hepatic viral infection, achieving 100% sensitivity under circum stances when abnormal values of GGT and serum bile acids occur respectively in 96 and 97% of patients [137], The long-term prog nosis of patients with viral hepatitis can partly be determined from biochemical data. Gitlin [48] examined 25 patients with severe viral hepatitis.…”

The pharmacokinetics of caffeine and its dimethylxanthine metabolites in patients with chronic liver disease.

“…Thus, in recent years, interest has been focused on developing methods to quantify hepatic function accurately. A number of such tests have been proposed, including measurement of fasting and 2 h post-prandial serum bile acid concentrations (Ferraris et al, 1983), measurement of the rate of galactose elimination (Tygstrup, 1964) and the use of a variety of breath tests employing radio-labelled aminopyrine (Bircher et al, 1976). In general these tests have not found favour, as they either confer no diagnostic benefit over more readily available laboratory tests or else they are costly, complex to perform or use test substances or procedures which are potentially harmful.…”

Colorimetric enzymatic measurement of serum total 3 alpha-hydroxy bile acid concentrations without extraction.

“…the present spectrophotometric technique in apparently fasting subjects;'3 22 23 others find these higher values only in non-fasting subjects.4 14 24 Perhaps the real difficulty lies in assuming that no contraction of the gallbladder or movement of the bile acid pool occurs during fasting. Of all the methods (enzymatic, radioimmunoassay, gas chromatography, gas chromatography-mass spectrometry, high pressure liquid chromatography-mass spectrometry) currently used to measure serum bile acid concentration, the enzymatic method is the least time consuming, complicated and expensive.…”

“…The limit of detection of this method was therefore regarded as 3 /LmoIl. [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] ,umolVl the CV was 10% (14.6 + 1-5; n = 9), and for those >25 ,umol/I the CV was 6-8% (63.1 ± 4-3; n -8).…”