Point-of-care continuous (13)C-methacetin breath test improves decision making in acute liver disease: results of a pilot clinical trial.
OBJECTIVE
To assess the role of the (13)C-methacetin breath test (MBT) in patients with acute liver disease.


METHODS
Fifteen patients with severe acute liver disease from diverse etiologies were followed-up with (13)C-MBT during the acute phase of their illnesses (range 3-116 d after treatment). Patients fasted for 8 h and ingested 75 mg of methacetin prior to the MBT. We compared results from standard clinical assessment, serum liver enzymes, synthetic function, and breath test scores.


RESULTS
Thirteen patients recovered and two patients died. In patients that recovered, MBT parameters improved in parallel with improvements in lab results. Evidence of consistent improvement began on day 3 for MBT parameters and between days 7 and 9 for blood tests. Later convergence to normality occurred at an average of 9 d for MBT parameters and from 13 to 28 d for blood tests. In both patients that died, MBT parameters remained low despite fluctuating laboratory values.


CONCLUSIONS
The (13)C-MBT provides a rapid, non-invasive assessment of liver function in acute severe liver disease of diverse etiologies. The results of this pilot clinical trial suggest that the MBT may offer greater sensitivity than standard clinical tests for managing patients with severe acute liver disease.
Lalazar
Gadi
G
Gastroenterology and Liver Units, Department of Medicine, Hadassah-Hebrew University Medical Center, Ein-Kerem, Jerusalem, Israel.
Adar
Tomer
T
Ilan
Yaron
Y
D000081:Acetamides / Q000032:analysis*; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D001944:Breath Tests / Q000379:methods*; D002247:Carbon Isotopes / Q000032:analysis; D005260:Female; D006505:Hepatitis / Q000175:diagnosis; D006509:Hepatitis B / Q000175:diagnosis; D006527:Hepatolenticular Degeneration / Q000175:diagnosis; D006801:Humans; D007557:Israel; D008099:Liver / Q000293:injuries; D008107:Liver Diseases / Q000175:diagnosis*; D008111:Liver Function Tests; D008297:Male; D018579:Patient Selection; D010865:Pilot Projects; D019095:Point-of-Care Systems; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis; D012016:Reference Values; D055815:Young Adult
D000081:Acetamides; D002247:Carbon Isotopes; C035495:methacetin