Value of Liver Function Tests in Cirrhosis

Sharma, Praveen

doi:10.1016/j.jceh.2021.11.004

Cited by 36 publications

(23 citation statements)

References 121 publications

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“…The severity of liver dysfunction is often estimated using the MELD score or CTP classification. MELD is a continuous score derived from the calculation of serum creatinine and bilirubin levels and the international normalized PT ratio ( 55 – 57 ). However, MELD has been widely adopted for end-stage cirrhotic patients awaiting liver transplantation ( 2 ) and is specifically designed for patients with end-stage cirrhosis ( 58 – 60 ).…”

Section: Discussionmentioning

confidence: 99%

Association of easy albumin-bilirubin score with increased mortality in adult trauma patients

Hsu,

Rau,

Tsai

et al. 2024

Front. Surg.

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IntroductionThe easy albumin-bilirubin (EZ-ALBI) score is calculated using the equation: total bilirubin (mg/dl) − 9 × albumin (g/dl), and is used to evaluate liver functional reserve. This study was designed to investigate whether the EZ-ALBI score serves as an independent risk factor for mortality and is useful for stratifying the mortality risk in adult trauma patients.MethodsWe retrospectively reviewed data from the registered trauma database of the hospital and included 3,637 adult trauma patients (1,241 deaths and 2,396 survivors) due to all trauma caused between January 1, 2009, and December 31, 2021. The patients were allocated to the two study groups based on the best EZ-ALBI cutoff point (EZ-ALBI = −28.5), which was determined based on the area under the receiver operating characteristic curve.ResultsResults revealed that the non-survivors had a significantly higher EZ-ALBI score than the survivors (−26.4 ± 6.5 vs. −31.5 ± 6.2, p < 0.001). Multivariate logistic regression analysis revealed that EZ-ALBI ≥ −28.5was an independent risk factor for mortality (odds ratio, 2.31; 95% confidence interval, 1.63–3.28; p < 0.001). Patients with an EZ-ALBI score ≥ −28.5 presented with 2.47-fold higher adjusted mortality rates than patients with an EZ-ALBI score < −28.5. A propensity score-matched pair cohort of 1,236 patients was developed to reduce baseline disparities in trauma mechanisms. The analysis showed that patients with an EZ-ALBI score ≥ −28.5 had a 4.12 times higher mortality rate compared to patients with an EZ-ALBI score < −28.5.ConclusionThe EZ-ALBI score was a significant independent risk factor for mortality and can serve as a valuable tool for stratifying mortality risk in adult trauma patients by all trauma causes.

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Section: Discussionmentioning

confidence: 99%

Association of easy albumin-bilirubin score with increased mortality in adult trauma patients

Hsu,

Rau,

Tsai

et al. 2024

Front. Surg.

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“…www.nature.com/scientificreports/ Assessment of hepatic function in clinical routine is done by several ways but each of them bears their own limitations. They consist of measurements of single liver parameters including ALT or AST, markers of cholestasis, albumin, and prothrombin time or combinations of blood parameters in form of various indices such as the FIB-4 score 27 . Imaging-based assessment of the liver, i.e.…”

Section: Discussionmentioning

confidence: 99%

The relationship between homoarginine and liver biomarkers: a combination of epidemiological and clinical studies

Aghdassi

Schwedhelm

Atzler

et al. 2023

Sci Rep

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Homoarginine (hArg) is a non-essential cationic amino acid which inhibits hepatic alkaline phosphatases to exert inhibitory effects on bile secretion by targeting intrahepatic biliary epithelium. We analyzed (1) the relationship between hArg and liver biomarkers in two large population-based studies and (2) the impact of hArg supplementation on liver biomarkers. We assessed the relationship between alanine transaminase (ALT), aspartate aminotransferase (AST), γ-glutamyltransferase (GGT), alkaline phosphatases (AP), albumin, total bilirubin, cholinesterase, Quick’s value, liver fat, and Model for End-stage Liver Disease (MELD) and hArg in appropriately adjusted linear regression models. We analyzed the effect of L-hArg supplemention (125 mg L-hArg daily for 4 weeks) on these liver biomarkers. We included 7638 individuals (men: 3705; premenopausal women: 1866, postmenopausal women: 2067). We found positive associations for hArg and ALT (β 0.38 µkatal/L 95% confidence interval (CI): 0.29; 0.48), AST (β 0.29 µkatal/L 95% CI 0.17; 0.41), GGT (β 0.033 µkatal/L 95% CI 0.014; 0.053), Fib-4 score (β 0.08 95% CI 0.03; 0.13), liver fat content (β 0.016% 95% CI 0.006; 0.026), albumin (β 0.030 g/L 95% CI 0.019; 0.040), and cholinesterase (β 0.003 µkatal/L 95% CI 0.002; 0.004) in males. In premenopausal women hArg was positively related with liver fat content (β 0.047% 95%CI 0.013; 0.080) and inversely with albumin (β − 0.057 g/L 95% CI − 0.073; − 0.041). In postmenopausal women hARG was positively associated with AST (β 0.26 µkatal/L 95% CI 0.11; 0.42). hArg supplementation did not affect liver biomarkers. We summarize that hArg may be a marker of liver dysfunction and should be explored further.

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“…The AUCs of FLIS at 5, 10 and 15 min after enhancement for predicting ICG-R 15 of 10% or less were 0.838, 0.802 and 0.723, respectively ( p < 0.001); those for predicting ICG-R 15 of greater than 20% were 0.793, 0.824, and 0.756, respectively ( p < 0.001); those for predicting ICG-R 15 of greater than 40% were 0.728, 0.755 and 0.741, respectively ( p < 0.01); those for predicting ALBI grade were 0.734, 0.761, and 0.691, respectively ( p ≤ 0.001); those for predicting CP A cirrhosis were 0.806, 0.821, and 0.829, respectively ( p < 0.001); those for predicting MELD score of 10 or less were 0.837, 0.877, and 0.837, respectively ( p < 0.001). Previous studies have shown that patients have a good liver function and bisector ectomy can be done if ICG-R 15 is between 0 and 10%; it is a contraindication for major hepatectomy and right sided section ectomy or left sided hepatectomy can be done if ICG-R 15 is between 10 and 19%; it indicates the poor liver compensatory function, which is a contraindication for liver resection, and enucleation can be done if ICG-R 15 is greater than 40% ( Imamura et al, 2005 ; Sharma., 2022 ). FLIS provided acceptable diagnostic performance for detecting patients with ICG-R 15 of greater than 20% or 40%, which is crucial for treatment planning in hepatocellular carcinoma (HCC) patients and prevention of post-hepatectomy hepatic insufficiency.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of liver function in patients with liver cirrhosis and chronic liver disease using functional liver imaging scores at different acquisition time points

Tang

Liu

et al. 2022

Front. Genet.

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Purpose: This paper aims to explore whether functional liver imaging score (FLIS) based on Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI) images at 5, 10, and 15 min can predict liver function in patients with liver cirrhosis or chronic liver disease and its association with indocyanine green 15-min retention rate (ICG-R15), Child-Pugh (CP) score, albumin-bilirubin (ALBI) score, and model for end-stage liver disease (MELD) score. In addition, it also examines the inter- and intra-observer consistency of FLIS and three FLIS parameters at three different time points.Methods: This study included 110 patients with chronic liver disease (CLD) or liver cirrhosis (LC) (93 men, 17 women; mean ± standard deviation = 56.96 ± 10.16) between July 2019 and May 2022. FLIS was assigned in accordance with the sum of the three hepatobiliary phase characteristics, all of which were scored on the 0–2 ordinal scale, including the biliary excretion, hepatic enhancement and portal vein signal intensity. FLIS was calculated independently by two radiologists using transitional and hepatobiliary phase images at 5, 10, and 15 min after enhancement. The relationship between FLIS and three FLIS quality scores and the degree of liver function were evaluated using Spearman’s rank correlation coefficient. The ability of FLIS to predict hepatic function was investigated using receiver operating characteristic (ROC) curves.Results: Intra- and inter-observer intraclass correlation coefficients (ICCs) (ICC = 0.937–0.978, 95% CI = 0.909–0.985) for FLIS at each time point indicated excellent agreement. At each time point, FLIS had a moderate negative association with liver function classification (r = [−0.641]-[−0.428], p < 0.001), and weak to moderate correlation with some other clinical parameters except for creatinine (p > 0.05). FLIS showed moderate discriminatory ability between different liver function levels. The area under the ROC curves (AUCs) of FLIS at 5, 10, and 15 min after enhancement to predict ICG-R15 of 10% or less were 0.838, 0.802, and 0.723, respectively; those for predicting ICG-R15 greater than 20% were 0.793, 0.824, and 0.756, respectively; those for predicting ICG-R15 greater than 40% were 0.728, 0.755, and 0.741, respectively; those for predicting ALBI grade 1 were 0.734, 0.761, and 0.691, respectively; those for predicting CP class A cirrhosis were 0.806, 0.821, and 0.829, respectively; those for predicting MELD score of 10 or less were 0.837, 0.877, and 0.837, respectively. No significant difference was found in the AUC of FLIS at 5, 10 and 15 min (p > 0.05).Conclusion: FLIS presented a moderate negative correlation with the classification system of hepatic function at a delay of 5, 10, and 15 min, and patients with LC or CLD were appropriately stratified based on ICG-R15, ALBI grade, MELD score, and CP classification. In addition, the use of FLIS to evaluate liver function can reduce the observation time of the hepatobiliary period.

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Value of Liver Function Tests in Cirrhosis

Cited by 36 publications

References 121 publications

Association of easy albumin-bilirubin score with increased mortality in adult trauma patients

Association of easy albumin-bilirubin score with increased mortality in adult trauma patients

The relationship between homoarginine and liver biomarkers: a combination of epidemiological and clinical studies

Evaluation of liver function in patients with liver cirrhosis and chronic liver disease using functional liver imaging scores at different acquisition time points

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