Evaluation of hepatic function in liver cirrhosis: clinical utility of galactose elimination capacity, hepatic clearance of D-sorbitol, and laboratory investigations.
Assessment of hepatic function is based on both liver blood tests and functional tests, the extensive application of which is still controversial. The aim of this study was to evaluate the clinical utility of a few selected tests as discriminatory and prognostic indexes: serum albumin, pseudocholinesterase, prothrombin time, as well as galactose elimination capacity and hepatic sorbitol clearance. Two separate studies were performed: Study I to investigate how well these tests assessed severity, and Study II to evaluate their prognostic value. A total of 128 consecutive cirrhotic patients classified according to the Child-Pugh score were included in Study I; Study II was carried out on 47 of these 128 during a two-year follow-up period. Pairwise correlations between all tests and Child-Pugh score yielded higher significant values for liver blood tests than for the functional ones. In Study I functional tests such as galactose elimination capacity and hepatic sorbitol clearance did not appear to be better than conventional biochemical tests in discriminating clinical severity of cirrhotic patients, as defined by Child-Pugh classification. Results of Study II confirmed that in severe liver cirrhosis Child-Pugh score remains the best method for medium- and long-term prognosis and for planning liver transplantation. Functional tests should be reserved for defining the residual functioning liver mass or for studies about functional liver plasma flow.
Garello
E
E
Department of Gastroenterology, San Giovanni Battista Hospital of Turin, and University of Turin, Italy.
Battista
S
S
Bar
F
F
Niro
G A
GA
Cappello
N
N
Rizzetto
M
M
Molino
G
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D002091:Butyrylcholinesterase / Q000032:analysis; D002648:Child; D005260:Female; D005690:Galactose / Q000493:pharmacokinetics* / Q000652:urine; D006801:Humans; D008103:Liver Cirrhosis / Q000145:classification / Q000401:mortality / Q000503:physiopathology*; D008111:Liver Function Tests / Q000592:standards*; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D011237:Predictive Value of Tests; D011379:Prognosis; D012680:Sensitivity and Specificity; D012709:Serum Albumin / Q000032:analysis; D012720:Severity of Illness Index; D013012:Sorbitol / Q000097:blood / Q000493:pharmacokinetics* / Q000652:urine; D016019:Survival Analysis
D012709:Serum Albumin; D013012:Sorbitol; D002091:Butyrylcholinesterase; D005690:Galactose