Clinical significance of hippurate-synthesizing capacity in surgical patients with liver disease: a metabolic tolerance test.
Changes in the amount of hippurate synthesized and excreted in the urine after 1.5 gm benzoate loading (intravenous hippuric acid test [HAT]) in patients with liver disease before surgery were studied in relation to arterial blood ketone body ratio (acetoacetate/beta-hydroxybutyrate) (BKBR), reflecting energy status of the liver. In these patients, the HAT values for 120 minutes were decreased significantly (1.088 +/- 0.129 gm, n = 9; 1.071 +/- 0.258 gm, n = 7; 1.258 +/- 0.126 gm, n = 10; in cirrhosis with liver tumor, cirrhosis with esophageal varix, and obstructive jaundice, respectively) as compared with the value in patients without liver disease (1.829 +/- 0.093 gm, n = 16, P less than 0.01). The correlation coefficient of the BKBR and the HAT value was 0.766, which was higher than that of the BKBR and albumin or the BKBR and choline esterase (r = 0.532 and r = 0.646, respectively). Serum levels of glutamic-oxaloacetic transaminase, glutamic pyruvic transaminase, alkaline phosphatase, gamma-glutamyl transpeptidase, leucine aminopeptidase, total and direct bilirubin, creatinine, and blood urea nitrogen were not correlated with the HAT values. Because hippurate is synthesized in liver mitochondria by the continuous supply of adenosine triphosphate through mitochondrial oxidative phosphorylation, HAT is considered to be a test that evaluates the energetic capacity of the liver to manage a metabolic load imposed on it.
D000328:Adult; D000368:Aged; D002802:Cholinesterases / Q000097:blood; D004734:Energy Metabolism; D005260:Female; D006626:Hippurates / Q000096:biosynthesis*; D006801:Humans; D007657:Ketone Bodies / Q000097:blood; D008099:Liver / Q000378:metabolism; D008107:Liver Diseases / Q000378:metabolism* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012709:Serum Albumin / Q000032:analysis
D006626:Hippurates; D007657:Ketone Bodies; D012709:Serum Albumin; D002802:Cholinesterases; C030514:hippuric acid