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PubMed1983

Assessment of liver function by the aminopyrine breath test.

The aminopyrine breath-test (ABT) has been proposed as a non-invasive quantitative test of liver function and reserve. To evaluate its usefulness, we compared the ABT with standard liver function tests, Child's classification of liver disease and ICG clearance, as means of assessing liver function in 30 patients with cirrhosis. The cumulative output of 14CO2 in breath during the 6 h following [14C]aminopyrine administration was significantly decreased in the cirrhotic group as compared with control subjects. The severity of liver dysfunction, as assessed by Child's classification, was associated with a progressive and statistically significant impairment of the ABT. There was a good correlation between the ABT and ICG systemic clearance (r = 0.770, P less than 0.001) and also between the ABT and ICG intrinsic clearance (r = 0.885, P less than 0.001), a measure which is independent of hepatic blood flow variations. These results further strengthen the concept that the ABT is a simple non-invasive method to assess quantitatively liver function and reserve, and could be useful in following the evolution of patients with liver disease.

Adult↗
PubMed2003

Liver function tests during antithyroid therapy in hyperthyroidism.

AIMS: To investigate the liver function tests during antithyroid treatment in the patients with hyperthyroidism. METHODOLOGY: Four hundred sixty five patients with hyperthyroidism (285 Graves' disease and 180 toxic nodular/multinodular goiter) and fifty healthy subjects were included in the study. The patients who had abnormal liver function tests were excluded from the study. Blood levels of thyrotropin (TSH), free thyroxine (FT4), alanine transaminase (ALT) and aspartate transaminase (AST) were detected at the beginning of the treatment (basal levels), and at the third and sixth months of the treatment. The patients were treated with propylthiouracil (PTU). RESULTS: Average of age was 40.1 +/- 5.8 years in the patient group and was 37.3 +/- 4.5 years in the control group. TSH, FT4, ALT and AST levels measured in the patient and control group are shown in Table 1. Basal levels of TSH were lower in the study group than in the control group (p<0.001), and basal levels of FT4 were higher in the study group than in the control group (p<0.001). Basal levels of ALT and AST, and the levels of TSH, FT4, ALT and AST measured at the third and sixth months were similar in both groups. CONCLUSIONS: We did not find abnormal liver function tests during the antithyroid treatment in the patients with hyperthyroidism.

Adult↗
PubMed1996

Liver function disturbances in Guillain-Barré syndrome: a prospective longitudinal study in 100 patients. Dutch Guillain-Barré Study Group.

In 100 consecutive patients with Guillain-Barré syndrome, we assessed liver function on admission and at fixed intervals after either intravenous immunoglobulin (IgIV) or plasma-exchange (PE) treatment. On admission, 38% showed a plasma alanine aminotransferase elevation, gamma glutamyl transferase elevation, or both or more than 1.5 times the upper limit of normal. Ten of these patients had serologic evidence of recent cytomegalovirus infection. The remaining 28 patients were negative for other known causes of liver damage, including infection with Epstein-Barr virus or hepatitis A, B, and C; alcohol abuse; hepatotoxic drugs; recent surgery; and concurrent liver disease. In a hospital control group of 100 consecutive patients with subarachnoid hemorrhage, only 5 had unexplained liver function disturbances on admission (p < 0.0001). In the IgIV-treated group, the percentage of patients with elevated liver function tests increased from 35% before to 69% shortly after treatment at 2 weeks postadmission (p < 0.005). In the PE-treated group, this percentage decreased somewhat from 41% to 36% (not significant). There was also a significant rise in median plasma activity of the various liver enzymes in the IgIV group. At 1 month, however, significant difference had disappeared. At 3 and 6 months, the percentage of patients with liver function disturbances reached a significantly lower level in both treatment groups compared with the time of admission. We concluded that many patients with Guillain-Barré syndrome had mild liver function disturbances without obvious cause. In addition, IgIV treatment was associated with mild transient liver function disturbances through an unknown mechanism.

Humans↗
PubMed1976

[Liver function in hormonal contraception].

Numerous interactions between hormonal contraceptives and liver function have been described. Changed laboratory results do not represent obligatory pathologic conditions or hepatotoxi effects. Some of these changed results are transient, suggesting that liver cells are capable of adaptation. The use of oral contraceptives is contraindicated in the following liver diseases: - recurrent intrahepatic cholestasis (recurrent jaundice of pregnancy, Dubin-Johnson syndrome, Rotor syndrome); - acute disturbances of liver function. In general it is recommended that hormonal contraceptives should not be used by patients with biliary cirrhosis although some authors have stated that chronic disturbances of liver function did not appear to be aggravated by these agents. Impairment of carbohydrate and lipid metabolism needs careful control of the laboratory tests concerned. Due to its low frequency the increased risk of gallstones does not necessitate the withdrawal of the medication. Up to now the interrelationship between the use of contraceptive steroids and the induction of hepatic tumours has not been proven.

5-Aminolevulinate Synthetase↗
PubMed1978

14C-D-galactose breath test for evaluation of liver function in patients with chronic liver disease.

D-Galactose metabolism and demethylation of aminopyrine by healthy controls and patients with chronic active hepatitis (CAH) and cirrhosis (Ci), were assessed by a breath analysis technique measuring 14CO2 exhalation after oral ingestion of 14C-D-galactose or 14C-aminopyrine. Patients with CAH and Ci exhibited decreased 14CO2-exhalation rates following 14C-D-galactose or 14C-aminopyrine. D-Galactose oxidation capacity of the liver can be assessed by a breath analysis technique in analogy to the demethylating function for aminopyrine. The ordinary oral D-galactose tolerance test seems, however, superior in comparison to the 14C-D-galactose tolerance test, in discriminating between healthy controls and patients with chronic liver disease.

Administration, Oral↗
PubMed1993

[Clinical evaluation of hepatic blood flow and liver function with 99mTc-DTPA-HSA].

Clinical evaluation of hepatic blood flow and liver function of 30 patients with 99mTc-human serum albumin scintigraphy (99mTc-HSA) was done. In this study we evaluated the ratio of portal venous to total hepatic blood flow as the hepatic perfusion index (HPI), and 99mTc-HSA uptake ratio of the liver to the heart at 2 hrs after bolus injection as the hepatic uptake score (HUS). In clinical study, we estimated both HPI and HUS in patients with liver cirrhosis (LC) and non-liver-cirrhosis (non-LC), and in the same way estimated these two factors in the patients before and after distal splenorenal shunt operations (DSRS). We also estimated the correlation of both HPI and HUS with other liver functions. Finally we made 3 dimensional liver imagings using 99mTc-HSA. The mean HPI was 0.42 +/- 0.24 in the LC group and 0.66 +/- 0.19 in the non-LC group (p < 0.02). The mean HUS was 0.50 +/- 0.17 in the LC group and 0.67 +/- 0.13 in the non-LC group (p < 0.02). The mean HPI decreased to 32-54% after the DSRS operation, but there was no such change with HUS. Correlation between HPI and KICG was significant (r = 0.51, p < 0.02), and there was also a correlation between HUS and PT, HPT (p < 0.02), and ICGR15 (p < 0.02). We concluded that HPI and HUS were both useful factors in estimating hepatic blood flow and liver function.

Female↗
PubMed1984

Acute doxorubicin toxicity. Relationship to pretreatment liver function, response, and pharmacokinetics in patients with acute nonlymphocytic leukemia.

To determine if there is a relationship between development of acute doxorubicin toxicity, pretreatment liver function studies, and response, 64 acute nonlymphocytic leukemia patients undergoing induction chemotherapy with doxorubicin and cytosine arabinoside were evaluated. No statistically significant correlation could be found between the development of acute toxicity (mucositis) and the number or type of abnormal pretreatment liver functions. Patients receiving full doses of doxorubicin with mild hepatic dysfunction as determined by bromsulphalein (BSP) retention and serum liver function studies had the same incidence of toxicity and complete response rate as those with normal hepatic function. There was no significant difference between duration of response (P = 0.41) or survival (P = 0.17) between the two groups. Ten patients receiving a decreased dose of doxorubicin due to hepatic dysfunction had the same complete response rate but a lower incidence of toxicity as patients receiving full doxorubicin dose. Pharmacokinetic data from fluorescence plasma assays suggest no difference among patients with normal or mildly abnormal liver function studies receiving full doxorubicin doses. The results suggest that leukemia patients with mild hepatic dysfunction receiving a combination of full-dose doxorubicin and cytosine arabinoside for acute leukemia will have the same plasma pharmacokinetics, incidence of toxicity, and complete response rate as those with normal hepatic function. Reduction of doxorubicin dose in patients with abnormal liver function tests results in lower plasma concentrations, less toxicity, and the same response rate, but may also yield a shorter duration of response and survival.

Adolescent↗
PubMed2000

Hepatitis B and C virus infections and liver function in AIDS patients at Chris Hani Baragwanath Hospital, Johannesburg.

BACKGROUND: Impaired liver function tests and co-infection with hepatitis viruses in AIDS patients are common in western countries. OBJECTIVE: To assess liver function and prevalence of co-infection with hepatitis B and hepatitis C viruses in AIDS patients at Chris Hani Baragwanath Hospital. DESIGN: A prospective study. SETTING: Chris Hani Baragwanath Hospital, Johannesburg, South Africa. PATIENTS: One hundred consecutive patients with AIDS admitted to Chris Hani Baragwanath Hospital. RESULTS: There were 52 males and 48 females aged 16 to 54 years (mean + SD: 34.6 + 7.5 years). The results of laboratory test were as follows: LFTs: bilirubin 11.8 (+15.6) mumol/l; AST: 79.6 (+/- 116.6) iu/L; alkaline phosphatase: 204.3 (+/- 237.4) i mu/L; albumin: 23.9 (+/- 6.2) g/l; CD4+ lymphocytes: 141.5 (+/- 168.6) microliters; CD8+: 666.9 (+/- 618.3) microliters; HBV - HbsAg: 6 (6%); HbsAg + eAg: 3 (3%); previous disease (Anti HBs and/or anti HBc): 35%, HCV: 1(1%). CONCLUSION: Liver function tests were impaired in the majority of patients with AIDS (93%) in our setting. Evidence of previous and present HBV infection was present in 41%. This is different from what is observed in western countries (90-95%). The results also suggest that patients here acquired HBV infection while still immuno competent. HCV infection was rare.

Acquired Immunodeficiency Syndrome↗
PubMed1998

[Abnormal liver function tests in the primary care setting].

Results of laboratory tests ordered during a primary care encounter may reveal findings of abnormal liver function tests, including elevated liver enzymes, hyperbilirubinemia, hypoalbuminemia or abnormal coagulation tests. The object of this study was to describe the spectrum of these liver function test (LFT) abnormalities in primary care. Results of all laboratory tests ordered during 10 months in an urban primary care clinic were retrospectively reviewed and the medical charts of patients with abnormal LFTs were studied. In 217/1088 (20%) of the tests at least 1 LFT abnormality was found in 156 patients. New diagnoses were made in 104 patients. The main diagnostic groups were: non-alcoholic fatty liver changes, Gilbert's disease, acute infectious hepatitis, alcoholic liver disease and cirrhosis and hepatotoxic drug injury. In 60 patients the physician classified the abnormality as negligible and not associated with significant disease. However, an abnormal test that had been ordered for evaluation of a specific complaint, was indeed likely to represent significant disease (X2 = 29.5, p < 0.001). We conclude that finding abnormalities in liver function tests is common in the primary care clinic but does not often indicate significant liver disease.

Adolescent↗
PubMedDate not supplied

Disappearance of hepatic encephalopathy and improvement of liver function after surgical treatment of portal-systemic shunt in a patient with liver cirrhosis.

Large portal-systemic shunts in cirrhotic patients often cause recurrent hepatic encephalopathy and might promote liver dysfunction because of the reduced portal blood flow. We report a case of liver cirrhosis in which hepatic encephalopathy disappeared and liver function improved together with an increase of hepatopetal portal blood flow and liver volume after shunt resection. A 70-year-old woman with liver cirrhosis was admitted because of recurrent disorientation. Serum ammonia levels ranged from 174 to 321 micrograms/dL. Computed tomography demonstrated an atrophic liver and a large shunt. Portography disclosed that this shunt originated from the superior mesenteric vein and flowed into the inferior vena cava, common iliac vein and ovarian vein. Portal blood flow was poor because of the deviation into this shunt. After the surgical resection of the shunt, ammonia levels were normalized and hepatic encephalopathy no longer occurred. Portography and computed tomography after surgery demonstrated that hepatopetal portal blood flow evidently improved and the liver volume increased (before 369; after 574 cm3). Two years after surgery, hepaplastin test and serum albumin level improved from 41 to 76% and from 2.7 to 3.4 g/dL, respectively. This case supports the effectiveness of shunt resection for hepatic encephalopathy and the deteriorated liver function in cirrhotic patients with large portal-systemic shunt.

Adult↗
PubMed2005

Pharmacokinetics of levetiracetam in patients with moderate to severe liver cirrhosis (Child-Pugh classes A, B, and C): characterization by dynamic liver function tests.

BACKGROUND: Levetiracetam is an antiepileptic drug approved for use as adjunctive therapy in adults with partial-onset seizures. We sought to investigate possible changes in the pharmacokinetics of levetiracetam and its metabolite ucb L057 in patients with liver cirrhosis, who may require dose adjustments. METHODS: A single dose of levetiracetam was administered to 5 healthy subjects and to patients with Child-Pugh class A (n = 5), B (n = 6), or C (n = 5) alcohol-induced cirrhosis. The pharmacokinetics of levetiracetam and ucb L057 was measured and correlated with biochemical liver function parameters, with creatinine clearance, and with kinetics of caffeine, lidocaine, and d -sorbitol as probes for specific liver functions. RESULTS: Dynamic liver function tests revealed a deterioration of liver function. The pharmacokinetics of levetiracetam and its metabolite did not differ between healthy subjects and those with class A or B cirrhosis. However, in patients with class C cirrhosis, levetiracetam total clearance was reduced by 57% (90% confidence interval [CI], 43%-67%; P < .001). The geometric mean ratio of the area under the plasma concentration-time curve for levetiracetam, Child-Pugh class C versus control, was 2.41 (90% CI, 1.80-3.23), and the geometric mean of the half-life ratio was 2.27 (90% CI, 1.74-2.97). This was explained by the deterioration of renal function in patients with severe hepatic disease. CONCLUSIONS: In pharmacokinetic studies of hepatic impairment, including all classes of cirrhosis may be more revealing than including only selected classes of liver failure. No dose adjustment of levetiracetam is necessary in patients with mild to moderate liver impairment; however, patients with severe cirrhosis should initially receive only half of the commonly recommended dose.

Adult↗
PubMed2005

Evaluation of effect of hemihepatic vascular occlusion and the Pringle maneuver during hepatic resection for patients with hepatocellular carcinoma and impaired liver function.

Reducing blood loss during resection of hepatocellular carcinoma (HCC) in patients with impaired liver function is important. This study evaluated the effect and safety of inflow occlusion (hemihepatic vascular occlusion and the Pringle maneuver) in reducing blood loss during hepatectomy. A total of 120 HCC patients with impaired liver function (with a preoperative indocyanine green retention rate at 15 minutes > 10%) who underwent hepatectomy were included in this retrospective study. Patients were divided into three groups, no-occlusion (n = 30), hemihepatic vascular occlusion (n = 49), and Pringle maneuver (n = 41). There was one hospital death in each group. Of all three groups, 50 patients (41.7%) had blood loss less than 1000 ml. The three groups were similar in terms of clinocopathological features. All patients underwent minor resection. Blood loss was significantly greater in the no-occlusion group; there was no difference between the hemihepatic group and the Pringle group. Multivariate analysis revealed that risk factors related to blood loss included no inflow occlusion [odds ratios (ORs), 2.93; 95% confidence intervals (CIs) 1.13-7.59], tumor centrally located (ORs, 3.85; 95% CIs, 1.50-9.90), serum albumin level < 3.5 gm/dl (ORs, 5.15; 95% CIs, 1.20-22.07), and serum alanine aminotransferase >120 U/l (ORs, 3.58; 95% CIs, 1.19-10.80). For patients with occlusion time > or = 45 minutes, postoperative serum total bilirubin and aspartate aminotransferase levels in the Pringle group were significantly higher than those in the hemihepatic and no-occlusion groups (P < 0.05). In HCC patients with impaired liver function undergoing hepatectomy, both hemihepatic vascular occlusion and the Pringle maneuver are safe and effective in reducing blood loss. Patients subjected to hemihepatic vascular occlusion responded better than those subjected to the Pringle maneuver in terms of earlier recovery of postoperative liver function, especially when occlusion time was > or = 45 minutes.

Aged↗
PubMed1987

Liver function abnormalities in chronic heart failure. Influence of systemic hemodynamics.

To characterize the incidence and severity of liver function abnormalities in patients with congestive heart failure, we analyzed systemic hemodynamics and biochemical profiles in 133 patients with stable chronic congestive heart failure, secondary to a dilated cardiomyopathy. The patients were divided into three groups, based on the severity of the reduction in cardiac index (CI). The mean values of all liver function tests in groups 1 (n = 43; CI greater than or equal to 2.0 L/min/m2) and 2 (n = 48; CI greater than 1.5 and less than 2.0 L/min/m2) were essentially normal, except for minimally elevated alkaline phosphatase levels and slightly decreased albumin levels in both groups, and slight increases in levels of gamma-glutamyl transpeptidase and total bilirubin in group 2. In contrast, group 3 patients (n = 42; CI less than or equal to 1.5 L/min/m2) had the most severe heart failure, as assessed by the lowest CI and highest cardiac filling pressures, and significantly higher levels of aspartate aminotransferase (65 +/- 82 U/L), alanine aminotransferase (77 +/- 102 U/L), lactate dehydrogenase (282 +/- 91 U/L), and total bilirubin (29 +/- 14 mumol/L [1.7 +/- 0.8 mg/dL]). The percentage of patients in group 3 with these abnormalities ranged between 27% and 80%. Although linear regression analysis showed that the elevations in right atrial and pulmonary wedge pressures, and the decreases in CI, were significantly correlated with liver function abnormalities, the correlation coefficients were small. Thus, liver function abnormalities remain common in patients with congestive heart failure but are generally small in magnitude and not associated with clinically apparent hepatic disease. It is likely that reduced forward flow and passive backward congestion are both contributing factors in the pathogenesis of these biochemical abnormalities, although nonhemodynamic factors may also be important.

Adult↗
PubMed1999

Lidocaine and monoethylglycinexylidide serum determinations to analyze liver function of cirrhotic patients after oral administration.

Our aim was to compare standard liver function tests (serum bilirubin, serum albumin and prothrombin concentration), with lidocaine and monoethylglycinexylidide pharmacokinetic parameters, after oral lidocaine administration, to assess hepatic function of cirrhotic individuals. Twenty-one consecutive cirrhotic patients, nine consecutive acute hepatitis patients, and nine healthy individuals received oral lidocaine. Lidocaine and monoethylglycinexylidide serum concentrations were determined by the TDx system. Cirrhotic patients had higher lidocaine and lower monoethylglycinexylidide serum concentrations and differences in its pharmacokinetic variables, compared to control and hepatitis groups (P < 0.05). Sensitivity of lidocaine serum determinations (100%) was greater than sensitivity of serum bilirubin (57%), serum albumin (62%), and prothrombin concentrations (43%) and monoethylglycinexylidide serum concentrations (57%) in differentiating cirrhotic individuals from controls. In conclusion, after oral administration, lidocaine and monoethylglycinexylidide pharmacokinetic parameters are significantly altered in cirrhotic patients compared to normal and acute hepatitis subjects. Lidocaine pharmacokinetic parameters would be better than those of monoethylglycinexylidide and standard liver function tests in the evaluation of liver function of cirrhotic patients.

Administration, Oral↗
PubMed1990

Liver function assessment by drug metabolism.

Liver function can be assessed by administering an exogenous substance to quantify changes in hepatic blood flow, uptake, biotransformation, and excretion. Characterization of drug half-life, clearance, and product formation rates are possible methods for measuring hepatic efficiency. Allopurinol and caffeine have been used to measure metabolite formation followed by renal elimination of both parent substance and metabolite. Sorbitol, a substance with high intrinsic clearance, can reflect liver blood flow, while trimethadione, a low-extraction drug, has been used to measure liver enzyme capacity. Metabolites from lidocaine, methacetin, and aminopyrine have been measured in serum, urine, and breath tests. Salivary clearance measurements of caffeine and antipyrine are reported as suitable for routine use. Genetic diversity of isoenzymes and the many metabolic processes used by hepatocytes make it extremely difficult to quantify functional changes with one substance. Combinations of model substrates have been suggested to assess the many hepatic processes.

Acetamides↗
PubMed2000

Normal liver function in women in the general Japanese population subjected to environmental exposure to cadmium at various levels.

OBJECTIVES: Whereas it is well established that environmental exposure to cadmium (Cd) may induce kidney dysfunction, less attention has been paid to the possible disturbance of liver function by Cd exposure. The possibility that liver function is adversely affected by current levels of environmental exposure to Cd as investigated in women in the general population in Japan, where the background level of exposure to Cd is known to be high. METHODS: From 1991 to 1997, 24-h food duplicate, peripheral blood and morning spot urine samples were collected from 607 non-smoking and non-habitually drinking women (age range 19-78 years) at 30 survey sites (with no known environmental pollution from heavy metals) throughout Japan. Liver function parameters in serum were examined by conventional methods. After wet-ashing, the food duplicate, blood and urine samples were analyzed for Cd intake via food (Cd-F), Cd in blood (Cd-B), and Cd in urine (Cd-U) by inductively-coupled plasma mass spectrometry. RESULTS: The geometric mean values for Cd-F, Cd-B, and Cd-U were 24.7 (27.1) microg/day, 1.76 (2.07) microg/l, and 3.94 (4.61) microg/g creatinine (values in parentheses for 41- to 60-year-old women), respectively. It as found that the three parameters of ALP, ALT, and AST activity were positively and significantly related to the age of the subjects (whereas no association as detected in cases of gamma-GTP, LAP, and albumin). Accordingly, a further analysis as made with 367 women selected by age (41-60 years; about 60% of the total population). Essentially, no Cd dose-dependent changes in liver function parameters were observed in the selected population of this narrower age range. CONCLUSIONS: Overall, it seemed prudent to conclude that liver function as not disturbed by the current environmental exposure to Cd in Japan.

Adult↗