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PubMed1987

The effects of liver directed radiotherapy and chemotherapy on liver function tests and hematological parameters in patients with surgically resected colon cancer: findings from the Gastrointestinal Tumor Study Group.

The effects on liver function tests of liver-directed radiation (RT) and systemic chemotherapy (CT) were examined at 6 months after initiation of treatment on two Gastrointestinal Tumor Study Group protocols. Data from patients on protocol GI 6175 (adjuvant CT or no adjuvant therapy) were used to evaluate the effect of CT alone, and data from patients on protocol GI 6179 (adjuvant CT plus liver directed RT or no adjuvant therapy) were used to evaluate the combined effects of CT and RT. Finally, data from patients on GI 6179 who received less than protocol specified RT doses were used to determine whether minor differences in dose are detectable via liver function tests. In 40 patients receiving CT, the serum level of alkaline phosphatase was not significantly increased (p = 0.14) compared to that of control patients whereas the level of serum glutamate oxoloacetate transaminase was significantly elevated (p = 0.03). In 31 patients receiving both CT and RT, both alkaline phosphatase and SGOT were significantly elevated (both p = 0.03). In addition, in 19 patients who received less than full RT doses, the changes in dose were not detectable from those patients who received full dose (all p greater than 0.10). In summary, CT alone may elevate hepatocellular enzymes, whereas a combination of CT and liver-directed RT is associated with a significant increase in both SGOT and alkaline phosphatase. Small alterations in the dose of volume of RT are not detectable by liver function test variations.

Alkaline Phosphatase↗
PubMed1991

Caffeine clearance by enzyme multiplied immunoassay technique: a simple, inexpensive, and useful indicator of liver function.

The clinical value and sensitivity of serum caffeine clearance measurement has been evaluated as an indicator of hepatic disease. After a 17 hour caffeine exclusion period, 300 mg of caffeine citrate was administered orally to the study subjects. Serum samples were taken four and 16 hours later. Serum caffeine concentrations were measured using an enzyme multiplied immunoassay technique (EMIT) and a clearance value derived. Conventional liver function tests were measured at the same time. A total of 103 subjects attending the medical unit in a district general hospital were studied. Twenty one had alcoholic liver disease, 11 non-alcoholic cirrhosis, nine non-cirrhotic liver disease, 21 suspected liver disease, six hepatic tumours, and 35 were hospital and normal control subjects. Caffeine clearance values were lowest in subjects with alcoholic liver disease (median 0.19 ml/min/kg, range 0.04-0.61 ml/min/kg) and significantly reduced in all subjects with liver disease (median 0.32 ml/min/kg, range 0.04-2.68 ml/min/kg) compared with control subjects (median 1.27 ml/min/kg, p less than 0.001). In subjects with suspected liver disease subsequently shown to have another explanation for abnormal liver function test results, caffeine clearance values were normal (median 1.31 ml/min/kg, range 0.23-2.64 ml/min/kg) and significantly different, p less than 0.001, from those of subjects with liver disease. Serum albumen values were not different for these latter two groups. Using a cut off value of 0.86 ml/min/kg, caffeine clearance measurement was 100% sensitive for alcoholic liver disease and 89% sensitive for all liver disease. The respective sensitivities for conventional liver function test measurement were 76% and 83%. In the suspected liver disease group, caffeine clearance was abnormal in only 24%, conventional liver function tests were abnormal in 95%. The respective specificities for caffeine clearance and liver function test measurement in control subjects were 93% and 100%. Caffeine clearance determined by EMIT is a simple inexpensive hepatic metabolic function test. This study indicates that it is a more sensitive indicator of structural liver disease than conventional liver function tests, especially for alcoholic liver disease. The test could be widely introduced as a useful, repeatable assessment of hepatic function.

Adult↗
PubMed1993

Effects of nifedipine on functional liver plasma flow in normal subjects and in patients with cirrhosis.

The short-term effects of nifedipine (10 mg administered sublingually) on functional liver plasma flow, measured by calculating the extrarenal clearance of sorbitol, were investigated in 12 normal volunteers and 40 patients with cirrhosis scored according to Child-Pugh classification. Nifedipine significantly increased functional liver plasma flow in healthy subjects (23%, p < 0.0001) and in patients with cirrhosis in the Child-Pugh class A group (19%, p < 0.001); in patients in the Child-Pugh class B group functional liver plasma flow was not modified, whereas in the patients in the Child-Pugh class C group it was significantly reduced (-7%, p < 0.02). The mean arterial pressure showed a significant reduction in all groups studied. According to the pathophysiologic meaning of functional liver plasma flow, it is suggested that nifedipine meets criteria for an ideal test substance to evaluate the functional reserve of the liver. Furthermore, when used with the Child-Pugh classification, its effect on functional liver plasma flow may be useful to improve the efficiency of the Child-Pugh classification, in establishing the prognosis of patients with cirrhosis.

Adult↗
PubMed2004

True versus mild hyperthermia during isolated hepatic perfusion: effects on melphalan pharmacokinetics and liver function.

Hyperthermic antiblastic isolated hepatic perfusion (IHP) with melphalan has been recently proposed as an alternative therapeutic option for patients with unresectable liver tumors. Although melphalan-heat antiblastic synergism is at a maximum at temperatures higher than 41 degrees C, IHP has so far been performed in humans at lower temperatures. In this experimental work, we compared IHP under mild versus true hyperthermic conditions in terms of drug pharmacokinetics and liver function. Ten pigs were submitted to IHP with melphalan 1.5 mg/kg at a mean temperature of 40 degrees C (group A, n = 5) or 42 degrees C (group B, n = 5). After a 60-minute perfusion, a 15-minute washout was performed. Perfusate-to-plasma leakage was monitored using scintigraphy. Throughout perfusion, samples from the systemic blood, perfusate, and liver parenchyma were obtained to measure melphalan concentrations. Liver function was assessed using standard blood tests and the indocyanine green-based test. No deaths related to the IHP procedure were recorded. All animals had transient liver function impairment, with all liver function test results returning to normal within the observation period. At histologic examination, liver damage was similar under both hyperthermic conditions. Melphalan levels in the perfusate were not significantly different in the two study groups (the mean perfusate/plasma area under the curve from 0 to 60 minutes ratios were 463 and 501, respectively). These results correlated well with those obtained using the scintigraphic method. Liver drug concentrations remained unchanged after true hyperthermia IHP. Under true hyperthermic conditions, neither an increase in liver parenchyma toxicity nor changes in melphalan pharmacokinetics were observed. These findings support the use of true hyperthermia in the clinical setting to exploit fully the antitumor synergism between melphalan and heat.

Animals↗
PubMed2002

Intraoperative hemodynamics and liver function in adult-to-adult living liver donors.

Indocyanine green (ICG) can be used to measure cardiac output (CO), hepatic function, and blood volume. We used ICG to describe the effect of right hepatectomy for living liver donation on intraoperative hemodynamics and perioperative liver function. ICG disposition was determined in 12 healthy adult living liver donors during the dissection phase and immediately after removal of the right hepatic lobe. In addition, measurements were repeated postoperative day 5. After injecting ICG, plasma concentrations were obtained for approximately 10 minutes by noninvasive pulse dye densitometry. CO was significantly higher and systemic vascular resistance was significantly lower immediately after removal of the right lobe compared with those obtained before resection (6.02 +/- 1.12 v 10.28 +/- 3.84 L/min; P < .05; 639 +/- 254 v 1,007 +/- 264 dyn x s x cm(-5); P < .05). Heart rate also increased significantly after removal of the right lobe from 62 +/- 10 to 83 +/- 9 beats/min (P < .05). Mean arterial pressure and central venous pressure were not different between measurements. The average elimination rate constant of ICG (K(ICG)) was reduced by more than 50% immediately after resection of the right lobe in comparison to baseline (0.25 +/- 0.096 v 0.12 +/- 0.03; P < .05). Day 5, K(ICG) was still decreased from baseline (0.25 +/- 0.096 v 0.16 +/- 0.04; P < .05), but approximately 25% greater than the immediate postresection K(ICG) (0.16 +/- 0.04 v 0.12 +/- 0.03; P > .05). Findings show profound intraoperative hemodynamic changes during living liver donation. In addition, we show that functional recovery of the liver is likely to be slower than morphological recovery, and such clinical parameters as coagulation profile may not be a good index of fully restored hepatic function.

Adult↗
PubMed1988

[Comparison of quantitative liver function tests to clinical, laboratory chemical and biopsy findings in patients with liver diseases].

Quantitative liver function tests (QLFT), e.g. 1) galactose elimination capacity (GEK) and 2) fractional indocyanine-green elimination constant k (ICG) were performed in patients with various liver diseases. Retrospectively the results of QLFT were compared to clinical, histological and laboratory findings which are known to reflect severity of liver disease. Patients showing clinical symptoms like ascites and/or encephalopathy demonstrated lower values for GEK and ICG. In addition similar data were obtained for those patients who showed histological evidence of cirrhosis. When dividing up the group of cirrhotics according to PUGH's classification, correspondingly lower results of QLFT were observed between different PUGH classes, however, due to a substantial overlap an individual classification could not be achieved by QLFT. Compared to routine laboratory tests which might estimate hepatic functional impairment the following correlations were found: GEK to albumin: r = 0.47, p < 0.01, to Quick: r = 0.44, p < 0.001, to bilirubin: r = -0.23, p < 0.05, ICG to albumin: r = 0.45, p < 0.01, to Quick: r = 0.53, p < 0.001, to bilirubin: r = -0.42, p < 0.001. No correlation could be demonstrated to transaminase activity. The results obtained support the view that QLFT are capable of estimating hepatic function, however, compared to conventional characteristics of advanced liver disease only moderate correlations were detected. A superiority of quantitative liver function tests could not be detected.

Adult↗
PubMed1997

[Study on the evaluation of total and regional liver function using 99mTc-GSA dynamic SPECT].

To evaluate regional and total liver function, 99mTc-GSA dynamic SPECT was studied in 58 patients with various liver disease and 5 normal volunteers. Using dual-head gamma camera, 60 projection data (90 seconds/rotation) were acquired to obtain SPECT imaging. Forty continuous SPECT were obtained for 60 minutes. Time activity curve (TAC) of each voxel was created. The TAC was assumed to be equally the function of C(t) = Cmax (l-e-kt). The liver uptake rate (K value) was calculated using the least squares method. The product of K value and functional volume of each voxel was defined as liver functional index and the sum of the indices was defined as total liver functional index. The total liver functional index had good correlation with various liver function test, HH15, LHL15, and the index showed significant difference between each group of Child-Pugh's liver dysfunction stage. Because of unnecessariness of setting up the ROI, this method is simple and the result is no difference among operators. Three-dimensional liver functional index map exactly shows regional liver function. So that, this method seems to be useful for predicting the residual liver function after hepatectomy.

Adult↗
PubMed2005

High-density lipoprotein cholesterol as an indicator of liver function and prognosis in noncholestatic cirrhotics.

BACKGROUND AND AIMS: The liver plays a central role in production and degradation of lipoproteins. Declining lipoprotein cholesterol may reflect deteriorating liver function. METHODS: We reviewed the records of 248 veterans with noncholestatic cirrhosis followed in our clinics or referred for liver transplantation between January 1, 1997 and October 31, 2002 (analysis period) and confirmed our findings prospectively in 165 noncholestatic cirrhotic veterans newly referred for liver transplantation between November 1, 2002 and May 1, 2004 (validation period). RESULTS: In the analysis group, albumin, bilirubin, INR, and Model for End-Stage Liver Disease (MELD) score correlated strongly with high-density lipoprotein (HDL) cholesterol, weakly but significantly with total cholesterol and very-low-density lipoprotein cholesterol (VLDL), and poorly with low-density lipoprotein cholesterol (LDL). Transplant-free mortality at 90, 180, and 365 days was 17/201 (8.5%), 19/173 (11.0%), and 38/119 (31.9%), respectively. Death at all 3 time points was associated with significantly lower initial levels of HDL, VLDL, and total cholesterol, but not LDL cholesterol. Of the lipoproteins, HDL was the best predictor of survival at 180 and 365 days (concordance statistics .86+/-.05 and .78+/-.05, respectively). By multivariate logistic regression, HDL cholesterol and MELD score were independent predictors of survival at 6 and 12 months. By Cox regression, HDL cholesterol below 30 mg/dL was associated with 3.4-fold increase in the hazard ratio for cirrhotic death. In the validation period, HDL cholesterol was confirmed to be significantly associated with death or transplantation at 6 or 12 months. CONCLUSIONS: HDL cholesterol in noncholestatic cirrhotic patients is a liver function test and an indicator of prognosis.

Biomarkers↗
PubMed1975

Liver morphology and liver function before and after intestinal shunt operation for obesity.

Liver biopsy and liver function tests were performed in 17 obese patients before and 14 months after intestinal shunt operation for obesity. In another 20 patients liver biopsy was performed postoperative only, in 12 patients preoperatively only. Steatosis was present in 85 per cent. of the patients before the operation. After the operation steatosis decreased in half the patients and increased in the other half. In patients with biopsy twice postoperatively there was a significant trend of decreasing steatosis up to 56 months after the operation. No patient developed cirrhosis during the time of observation. Within the first postoperative year there was a substantial and significant increase in serum alanine-aminotransferase and a minor increase in alkaline phosphatases and BSP. There was no correlation between the rate of weight loss and the change in steatosis or liver function.

Adolescent↗
PubMedDate not supplied

Liver function tests: their role in the diagnosis of hepatobiliary diseases.

Liver diseases are common, and currently represent the 12th leading cause of death in the United States. However, numerous hepatic disorders exist, and differential diagnosis often is difficult. Moreover, because laboratory testing is routine, an abnormal serum transaminase or alkaline phosphatase in patients without clinical symptoms is not uncommon. Although liver function tests are critical in recognizing the presence of liver disease and its specific diagnosis, the interpretation of the tests may be confusing and difficult. Furthermore, not all persons with one or more test abnormalities actually have liver disease. In this review, liver function tests and an approach to their interpretation are discussed.

Acute Disease↗
PubMed1994

Multi-variate stepwise discriminant analysis research affecting portal hypertension's grade factors of liver function.

The ideal time for selecting portal hypertension operation is the accurate judgement of the grade of liver function, yet the present criterion in grading liver function is controversial. 50 patients with 20 factors related to portal hypertension were undergone stepwise discriminant analysis by using SAS software on the IBM/PC computer (significance level alpha = 0.05). The results show that ascites degree prothrombin time (PT), serum total bilirubin, serum albumin content, main portal vein flow are significant factors. In the light of above variates contributing to grading liver function as to establish a discriminant equation, it was found that the total agreement rate between replaceable discrimination and original Child-Pugh classification is 86%. A test for agreement was performed between discriminant and original classification, showing that the two kinds of classification methods have a good agreement rates (Kappa = 0.7856), indicating the discriminant classification is of practical values.

Adult↗
PubMed2000

Carbamazepine and valproic acid: effects on the serum lipids and liver functions in children.

We aimed to determine the effects of carbamazepine, which induces liver microsomal enzymes, and valproic acid on the serum lipids and liver function test results in epileptic children. Thirty-eight epileptic children (18 males, 20 females, mean age 8.6 +/- 3.9 years) were evaluated for serum lipids and liver function test results at the onset and the second and sixth months of antiepileptic therapy. The results of the children receiving carbamazepine (n = 31) and valproic acid (n = 7) were compared. In addition, the values obtained at different periods of treatment were compared within each group. The differences in the serum lipid levels and liver function test results of the children in the carbamazepine group and the valproic acid group were not statistically significant throughout the study. However, the total cholesterol, low-density lipoprotein, total cholesterol/high-density lipoprotein, and gamma glutamyl transferase levels were significantly increased in the carbamazepine group during treatment (P < 0.05) but not in the valproic acid group. Carbamazepine treatment alters the serum lipid profile of the children in such a way that it facilitates the development of atherosclerosis. Valproic acid does not alter the levels of the serum lipids.

Adolescent↗
PubMed1982

Prognosis of hepatitis B virus surface antigen carriers in relation to routine liver function tests: a prospective study.

The employees of the Japan National Railways Co. working in the Tokyo area, comprising 98% men over the age of 40 yr, were examined for hepatitis B virus seromarkers and routine liver function tests (serum glutamic oxaloacetic transaminase, alkaline phosphatase, and zinc turbidity test) and were followed for 5 yr. The examinees included 202 hepatitis B surface antigen carriers, 502 positive for hepatitis B surface antibody, and 2426 negative for both. We found that the frequency of continuously abnormal liver function test was higher in hepatitis B surface antigen carriers compared with noncarriers. Of the 202 carriers, 4 (1.98%) died from hepatocellular carcinoma with or without cirrhosis, whereas in 2928 noncarriers only 2 (0.07%) died from liver diseases unrelated to hepatitis B virus, the difference being 28.3-fold. Three of the 4 who died from hepatocellular carcinoma initially had normal liver function tests. Mortality in carriers with initially normal liver function tests was 44.5 times higher than that in noncarriers with normal tests. Thus, asymptomatic carriers carry a high risk of dying from chronic liver disease. Routine liver function tests appear of limited value in predicting prognosis.

Adult↗
PubMed1994

Liver function and morphology during long-term fatty acid supplementation in cystic fibrosis.

Liver function tests and liver morphology were studied in 18 patients with cystic fibrosis (CF) for a period of 3 years. The patients were 5-19 years of age at the start of the study. Nine patients received regular supplementation of essential fatty acids (Intralipid) and nine sex- and age-matched patients, with as similar clinical status as possible but without fat emulsion treatment, were followed as controls. There were no significant differences between the two groups with regard to the parameters of liver function, including determinations of bile acids in serum and urine. Histological examinations of liver biopsies suggested less progression of liver disease in the fatty acid supplemented group, including fatty infiltration of the hepatocytes, evaluated morphometrically. The results show that regular supplementation of fat emulsions has no negative effects in the liver of patients with CF, and the lessening of progression of liver damage suggests that essential fatty acid deficiency might contribute to the liver damage in this disease.

Adolescent↗
PubMed1978

Liver function and lactate metabolism in the ill surgical patient.

Liver function and lactate metabolism were investigated in non-shocked, severely ill surgical patients. Fasting venous blood lactate concentration was increased and plasma liver function tests were abnormal in ill patients compared with controls. Ill patients were glucose-intolerant and blood lactate changes following intravenous glucose infusion were similar in both ill and control patients. Blood lactate half-life was increased in ill patients following a sodium L-lactate infusion, suggesting that the increased fasting lactate concentration may have been due to decreased hepatic removal rather than to increased peripheral production of lactate.

Aged↗