title: Enzymatic liver function capacity correlates with disease severity of patients with liver cirrhosis: a study with the LiMAx test.
abstract: BACKGROUND
  Assessment and quantification of actual liver function is crucial in patients with chronic liver disease to monitor disease progression and predict individual prognosis. Mathematical models, such as model for end-stage liver disease, are used for risk stratification of patients with chronic liver disease but do not include parameters that reflect the actual functional state of the liver.
  
  
  OBJECTIVE
  We aimed to evaluate the potential of a (13)C-based liver function test as a stratification tool by comparison with other liver function tests and clinical parameters in a large sample of healthy controls and cirrhotic patients.
  
  
  METHODS
  We applied maximum liver function capacity (LiMAx) to evaluate actual liver function in 347 patients with cirrhosis and in 86 controls.
  
  
  RESULTS
  LiMAx showed strong negative correlation with Child-Pugh Score (r = -0.707; p < 0.001), MELD (r = -0.686; p < 0.001) and liver function tests. LiMAx was lower in patients with liver cirrhosis compared to healthy controls [99 (57-160) µg/kg/h vs. 412 (365-479) µg/kg/h, p < 0.001] and differed among Child-Pugh classes [a: 181 (144-227) µg/kg/h, b: 96 (62-132) µg/kg/h and c: 52 (37-81) µg/kg/h; p < 0.001]. When stratified patients according to disease severity, LiMAx results were not different between cirrhotic patients and cirrhotic patients with transjugular intrahepatic portosystemic shunt.
  
  
  CONCLUSIONS
  LiMAx appears to provide reliable information on remnant enzymatic liver function in chronic liver disease and allows graduation of disease severity.
authors.affiliation: Department of General, Visceral and Transplantation Surgery, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany, maciej.malinowski@charite.de.
authors.forename: Maciej
authors.initials: M
authors.lastname: Malinowski
authors.forename: Maximilian
authors.initials: M
authors.lastname: Jara
authors.forename: Katja
authors.initials: K
authors.lastname: Lüttgert
authors.forename: James
authors.initials: J
authors.lastname: Orr
authors.forename: Johan Friso
authors.initials: JF
authors.lastname: Lock
authors.forename: Eckart
authors.initials: E
authors.lastname: Schott
authors.forename: Martin
authors.initials: M
authors.lastname: Stockmann
mesh_terms: D000328:Adult; D015415:Biomarkers; D002247:Carbon Isotopes / Q000378:metabolism; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008099:Liver / Q000201:enzymology*; D008103:Liver Cirrhosis / Q000201:enzymology* / Q000473:pathology; D008111:Liver Function Tests / Q000379:methods*; D008297:Male; D008875:Middle Aged; D055815:Young Adult
chemical_list: D015415:Biomarkers; D002247:Carbon Isotopes