title: Use of the methacetin breath test to classify the risk of cirrhotic complications and mortality in patients evaluated/listed for liver transplantation.
abstract: OBJECTIVE
  The MELD score predicts short-term mortality in patients with cirrhosis; however, some patients with low scores develop complications and die unexpectedly. Consequently, we evaluated the diagnostic accuracy of the methacetin breath test (MBT), an assay of liver metabolic function, and the MELD score, to predict the risk of complications of cirrhosis and liver-related death.
  
  
  METHODS
  One hundred sixty-five patients with cirrhosis received oral (13)C-methacetin; (13)CO2 was measured in expired breath (BreathID; Exalenz). The cumulative percent dose recovery of (13)CO2 at 20 min with a threshold of ⩽0.55% (high-risk) and >0.55% (low risk) most accurately predicted liver-related death and the risk of cirrhotic complications within one year. MELD thresholds of ⩾15 and ⩾19 were also examined to predict the same endpoints.
  
  
  RESULTS
  Dose recovery ⩽0.55% and MELD ⩾19 both predicted liver-related death (HR 12.6 [95% CI 1.6-98.3]; p=0.016, and HR 5.5 [1.6-18.9]; p=0.007, respectively); MELD ⩾15 did not. Dose recovery ⩽0.55% (HR 1.9 [1.1-3.2]; p=0.03) also predicted the risk of ⩾1 complication(s), and was particularly able to foretell the risk of development/exacerbation of ascites (HR 4.7 [1.8-11.9]; p=0.001), which was not achieved by either MELD threshold. Finally, in patients with MELD <19, dose recovery ⩽0.55% predicted the risk of death (p=0.017), development of ⩾1 cirrhotic complication(s) (p=0.062), and development/exacerbation of ascites (p=0.0009).
  
  
  CONCLUSIONS
  In this pilot study, methacetin breath testing predicted the risk of liver-related death and development/exacerbation of ascites more accurately than MELD ⩾15 or ⩾19. In patients with low MELD (<19points), MBT may be useful to identify patients in whom the frequency of clinical observation should be intensified.
authors.affiliation: Section of Hepatology, Hume-Lee Transplant Center of Virginia Commonwealth University, Richmond, VA, USA. Electronic address: rstravit@vcu.edu.
authors.forename: R Todd
authors.initials: RT
authors.lastname: Stravitz
authors.affiliation: Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Adrian
authors.initials: A
authors.lastname: Reuben
authors.affiliation: Hadassah Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Meir
authors.initials: M
authors.lastname: Mizrahi
authors.affiliation: Hadassah Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Gadi
authors.initials: G
authors.lastname: Lalazar
authors.affiliation: Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Kim
authors.initials: K
authors.lastname: Brown
authors.affiliation: Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Stuart C
authors.initials: SC
authors.lastname: Gordon
authors.affiliation: Hadassah Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Yaron
authors.initials: Y
authors.lastname: Ilan
authors.affiliation: Section of Hepatology, Hume-Lee Transplant Center of Virginia Commonwealth University, Richmond, VA, USA.
authors.forename: Arun
authors.initials: A
authors.lastname: Sanyal
mesh_terms: D000081:Acetamides; D000368:Aged; D001201:Ascites / Q000209:etiology; D001944:Breath Tests / Q000379:methods*; D058625:End Stage Liver Disease / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000401:mortality / Q000601:surgery*; D008111:Liver Function Tests / Q000379:methods; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D011237:Predictive Value of Tests; D011379:Prognosis
chemical_list: D000081:Acetamides; C035495:methacetin
keywords: Cirrhosis; Liver transplantation; MELD score; Methacetin