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PubMed1988

Abnormalities of urine urobilinogen and urine bilirubin assays and their relation to abnormal results of serum liver function tests.

A prospective observational study of 324 cases was conducted in a busy ambulatory care setting to evaluate the sensitivity, specificity, predictive values, and accuracy of spot urine urobilinogen and urine bilirubin assays as screening tests for serum liver function test (LFT) abnormalities. High positive predictive values (88% for at least one abnormal LFT) make the evaluation of positive urine screens detected during routine health care maintenance examinations imperative. Because extraneous factors may influence both urine and serum test results, however, urine assays obtained as a screening parameter in clinical presentations (abdominal pain, jaundice, constitutional symptoms, etc) have only limited clinical utility. The high proportion of false-negative results for both urine assays renders their statistical properties unacceptable as screens in these clinical situations.

Adolescent↗
PubMed1997

Liver function tests in pre-eclampsia: importance of comparison with a reference range derived for normal pregnancy.

OBJECTIVES: To determine reference ranges for liver function tests in uncomplicated pregnancy and to relate abnormal results by these criteria to outcome in pre-eclampsia. DESIGN: Prospective, cross-sectional study to establish the reference ranges. Prospective observational study of women with pre-eclampsia. SETTING: Antenatal clinics and obstetric unit of St Mary's Hospital, London. PARTICIPANTS: Four hundred and thirty women with uncomplicated pregnancies and 85 consecutive women with gestational hypertension. MAIN OUTCOME MEASURES: Aspartate transaminase (AST), alanine transaminase (ALT), bilirubin and gamma glutamyl transferase (GGT) were measured to determine their ranges in normal pregnancy. The severity of pre-eclampsia was determined by the maximum blood pressure, creatinine and 24 h urinary protein; minimum platelet count; maternal complications; mode of and gestation at delivery; and fetal outcome with centile weight adjusted for gestational age and sex. RESULTS: AST, ALT, bilirubin and GGT were each lower in uncomplicated pregnancy than the nonpregnant laboratory reference ranges. Of those cases with elevated liver function tests in the pre-eclampsia group, 37% were abnormal only by the new reference ranges. Using the new ranges, the prevalence of elevated liver function tests was significantly higher in the pre-eclampsia group (54%) than in those with pregnancy induced hypertension (14%) (P < 0.01). Amongst those with pre-eclampsia, abnormal liver function tests were associated with greater proteinuria (P < 0.05), lower platelet count (P < 0.001) and more maternal complications (P < 0.01) than normal liver function tests; there was no difference in the severity of hypertension between the groups. CONCLUSIONS: Liver function tests are lower in normal pregnancy than the reference ranges currently used. Our pregnancy-derived ranges allow more precise identification of abnormal liver function in women with pre-eclampsia than is possible using standard reference ranges derived from a nonpregnant population.

Adolescent↗
PubMed1985

Changes in liver function tests after propofol ('Diprivan').

Changes in three recognized liver function tests are reported following the use of propofol in 30 fit, unpremedicated women in whom propofol was used as the main anaesthetic agent. Doses of 140 to 330 mg were given, together with nitrous oxide and oxygen. All patients were undergoing minor gynaecological operations and all conformed to Grade 1 physical status of American Society of Anesthesiologists Classification. In none of these patients was there hypoxia or hypercarbia at any time during or following anaesthesia and none of the patients received any other drugs until completion of the study. No significant changes in liver enzymes (aspartate transaminase and alanine transaminase) or in serum alkaline phosphatase were detected.

Adult↗
PubMed1989

Failure of prediction of liver function test abnormalities with the urine urobilinogen and urine bilirubin assays.

A prospective observational study of 229 cases was conducted in a busy ambulatory care setting to evaluate the sensitivity, specificity, predictive values, and accuracy of spot urine urobilinogen and urine bilirubin assays as screening tests for serum liver function test (LFT) abnormalities. Both urine tests exhibited remarkably similar characteristics overall once they were adjusted to maximize accuracy and predictive values (occurring at a normal or abnormal "threshold," respectively, of 3.4 or 5.07 mumol/d for urobilinogen and 0 or 1+ for urine bilirubin). The percentage of cases correctly identified were 81% to 83% for serum bilirubin assays, 68% to 72% for other LFTs, but only 62% to 63% for screens for cases with at least one abnormal LFT finding. Poor sensitivities (47% to 49%) limited the detection of abnormal findings by the screen; both screens were reasonably specific (79% to 89%), but negative predictive values were suitable (89%) for serum bilirubin results only and were prohibitively lower (49% to 50%) in predicting all patients without LFT abnormalities. We conclude that spot urine urobilinogen and urine bilirubin determinations, although good screens for isolated serum bilirubin elevations, have unacceptable statistical properties as predictors of other LFT results due to a high proportion of false-negative results.

Bilirubin↗
PubMed1993

[Evaluation of lidocaine metabolite (monoethylglycinexylidide) as a liver function test].

In order to determine whether or not the lidocaine metabolism, monoethylglycinexylidide (MEGX) formation, could be used as a liver function test, we measured the serum levels of MEGX in 38 patients. There were significant correlations between values of MEGX (MEGX15, MEGX30, AUC15-30, AUC0-180) and conventional liver function tests (ICG R15, AT III, T. Bil). It appeared that value of MEGX 30 had maximum factor loading on conventional liver function tests by using principal component analysis. The advantage of adapting the MEGX formation as a liver function test of drug metabolism is simplicity of the method. MEGX formation could be useful index of the total liver function.

Evaluation Studies as Topic↗
PubMed1993

Liver function tests in the critically ill patient.

The liver has a wide range of functions that may be disturbed in different ways by the many diseases which affect it and, in consequence, there are a large number of tests which look at different aspects of its function. Specific diagnoses are made using a range of clinical, biochemical, histological and radiological methods. Measurement of the plasma concentration of alanine aminotransferase (ALT, SGPT), gamma-glutamyl transpeptidase (gammaGT) and albumin are particularly valuable as these substances are specifically affected by liver disease. Their elevation can reveal increases in the membrane permeability of hepatocytes (ALT), cholestasis and toxic damage (gammaGT), or an impairment of liver protein synthesis and secretion (albumin), respectively. If their activities remain within the normal range the likelihood of significant liver disease is less than 2%. A series of quantitative liver function tests are described which each examine one aspect of hepatic function. Table 1 lists several situations where the assessment of hepatic function is necessary. Liver function tests are classified in Table 2.

Critical Illness↗
PubMed1998

The utility of liver function test abnormalities concomitant with biliary symptoms in predicting a favorable response to endoscopic sphincterotomy in patients with presumed sphincter of Oddi dysfunction.

OBJECTIVES: We sought to study the utility of liver function test abnormalities concomitant with biliary symptoms in predicting a favorable response to endoscopic sphincterotomy in patients with Geenen class II sphincter of Oddi dysfunction. METHODS: We reviewed the clinical course and liver function test results of 24 Geenen-Hogan class II postcholecystectomy patients with biliary colic secondary to sphincter of Oddi dysfunction who did not undergo sphincter of Oddi manometry before treatment with endoscopic sphincterotomy. RESULTS: Twenty of the 24 patients had an average of 1.4 episodes of abnormal liver function tests associated with biliary colic; eight patients had dilated common bile duct on cholangiogram. Eighteen of the 20 patients with abnormal liver function tests (90%) were pain-free after sphincterotomy; in contrast, only one of four patients (25%) without liver function test changes responded to sphincterotomy. Fisher exact analysis showed that abnormal liver function tests was a significant predictor for favorable response to sphincterotomy with a two-tail p value of 0.018. Of the eight patients with bile duct dilatation, six (75%) responded favorably to sphincterotomy, whereas 13 of 16 patients (81%) without dilatation also responded to sphincterotomy. Analysis of common bile duct dilatation as a predictive factor showed no significance (p=1.00). CONCLUSIONS: We conclude that the occurrence of abnormal liver function tests during biliary colic may be used to select patients for endoscopic sphincterotomy. Sphincter of Oddi manometry may not be needed in these cases.

Adult↗
PubMed2006

Prognostic value of quantitative liver function tests in viral cirrhosis: a prospective study.

BACKGROUND AND AIMS: Widespread application of quantitative liver function tests as a prognostic tool is controversial. In this study we assessed the predictivity of serial evaluations of galactose elimination capacity (GEC) and the monoethylglycinexylidide (MEGX) test on survival in viral cirrhosis, and secondarily we compared these tests with Child-Turcotte-Pugh (CTP) and Model for End Stage Liver Disease (MELD) scores. METHODS: In a cohort of 35 patients with viral cirrhosis, GEC and MEGX were evaluated every 6 months for 24 months and compared with CTP and MELD scores at the same time intervals. The end points were patient death or liver transplantation. RESULTS: Statistically significant differences between dead/transplanted patients and survivors were found for basal values of GEC, MEGX, CTP and MELD. Receiver-operating characteristics curves of CTP and MELD scores showed a higher prognostic accuracy than GEC and MEGX. On multivariate analysis, neither GEC nor MEGX were independent predictors of survival. Repeated-measures analysis of GEC and MEGX did not increase the prognostic accuracy of these tests and did not add useful prognostic information on patient outcome during the following 6 months. CONCLUSIONS: Our data suggest that neither single nor repeated determinations of GEC and MEGX are superior to CTP and MELD scores in predicting prognosis of patients with viral cirrhosis.

Adult↗
PubMedDate not supplied

Fetal liver function tests: umbilical cord gamma-glutamyltransferase as a marker for fetal abnormality.

The objective was to assess the association of fetal liver function tests in various (noninfectious) abnormal fetal conditions. Liver function tests and complete blood counts were evaluated in 72 consecutive fetal blood specimens obtained by cordocentesis. The indications for cordocentesis included: fetal malformation (24), red blood cell alloimmunization (23), possible fetal infection (17), oligohydramnios (5), and immunologic thrombocytopenic purpura (3). Statistical analysis included analysis of variance and linear regression analysis. Liver function tests including total protein, albumin, total bilirubin, alanine and aspartate aminotransferase were all within the range of previously published normal values. However, fetal gamma-glutamyltransferase levels (mean +/- SEM) were 157.1 +/- 15.1 IU/l (norm: 24.4 +/- 1.2 IU/l; p < 0.001). There were no statistically significant differences in the gamma-glutamyltransferase levels between the various groups of fetal abnormalities. Mean fetal gamma-glutamyltransferase levels in 8 normal fetuses were 106.2 +/- 17.5 IU/l. In conclusion, fetal gamma-glutamyltransferase levels are significantly elevated in several abnormal fetal conditions.

Blood Cell Count↗
PubMedDate not supplied

Abnormal results of liver function tests in patients with Graves' disease.

OBJECTIVE: To determine the frequency of liver dysfunction in patients with hyperthyroidism. METHODS: We analyzed the clinical records of 30 consecutive patients with Graves' disease to identify the spectrum of abnormal results of liver function tests. The values for alkaline phosphatase (AP), aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma -glutamyltransferase (GGT), and total bilirubin were examined. RESULTS: The frequencies of increased levels of AP, AST, ALT, GGT, and bilirubin in the current study group were similar to but somewhat lower than those reported in previous studies. Of the 30 study patients, 11 (37%) had at least one abnormal result of a liver function test. All 30 patients in the study had determinations of AP (not fractionated), of which 10 values (33%) were above normal (range, 124 to 283 U/L). Of the 30 patients who had determinations of AST, 5 (17%) had increased values that ranged from 36 to 71 U/L. Six of the 23 patients (26%) with determinations of ALT had increased values that ranged from 45 to 157 U/L. Of the 25 patients who had measurements of GGT, 6 had above normal results (range, 69 to 331 U/L). In addition, 2 of the 24 patients (8%) with determinations of total bilirubin had increased levels. CONCLUSION: These findings indicate that abnormal results of liver function tests are common in patients with hyperthyroidism and make the diagnosis of concomitant, unrelated liver disease difficult until the euthyroid state has been established.

Adult↗