title: How to assess liver function?
abstract: OBJECTIVE
  The liver comprises a multitude of parenchymal and nonparenchymal cells with diverse metabolic, hemodynamic and immune functions. Available monitoring options consist of 'static' laboratory parameters, quantitative tests of liver function based on clearance, elimination or metabolite formation and scores, most notably the 'model for end-stage liver disease'. This review aims at balancing conventional markers against 'dynamic' tests in the critically ill.
  
  
  RESULTS
  There is emerging evidence that conventional laboratory markers, most notably bilirubin, and the composite model for end-stage liver disease are superior to assess cirrhosis and their acute decompensation, while dynamic tests provide information in the absence of preexisting liver disease. Bilirubin and plasma disappearance rate of indocyanine green reflecting static and dynamic indicators of excretory dysfunction prognosticate unfavorable outcome, both, in the absence and presence of chronic liver disease better than other functions or indicators of injury. Although dye excretion is superior to conventional static parameters in the critically ill, it still underestimates impaired canalicular transport, an increasingly recognized facet of excretory dysfunction.
  
  
  CONCLUSIONS
  Progress has been made in the last year to weigh static and dynamic tests to monitor parenchymal liver functions, whereas biomarkers to assess nonparenchymal functions remain largely obscure.
authors.affiliation: Department of Anaesthesiology and Critical Care Therapy, Friedrich-Schiller-University, Jena, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Kortgen
authors.forename: Peter
authors.initials: P
authors.lastname: Recknagel
authors.forename: Michael
authors.initials: M
authors.lastname: Bauer
mesh_terms: D000208:Acute Disease; D015415:Biomarkers; D002908:Chronic Disease; D003422:Critical Care; D016638:Critical Illness; D006801:Humans; D007362:Intensive Care Units; D008099:Liver / Q000473:pathology*; D008107:Liver Diseases / Q000175:diagnosis / Q000473:pathology; D017093:Liver Failure / Q000175:diagnosis* / Q000473:pathology; D008111:Liver Function Tests; D011379:Prognosis
chemical_list: D015415:Biomarkers