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Annals of Surgery Jan 2013To review the literature on the most clinically relevant and novel liver function tests used for the assessment of hepatic function before liver surgery. (Review)
Review
OBJECTIVE
To review the literature on the most clinically relevant and novel liver function tests used for the assessment of hepatic function before liver surgery.
BACKGROUND
Postoperative liver failure is the major cause of mortality and morbidity after partial liver resection and develops as a result of insufficient remnant liver function. Therefore, accurate preoperative assessment of the future remnant liver function is mandatory in the selection of candidates for safe partial liver resection.
METHODS
A MEDLINE search was performed using the key words "liver function tests," "functional studies in the liver," "compromised liver," "physiological basis," and "mechanistic background," with and without Boolean operators.
RESULTS
Passive liver function tests, including biochemical parameters and clinical grading systems, are not accurate enough in predicting outcome after liver surgery. Dynamic quantitative liver function tests, such as the indocyanine green test and galactose elimination capacity, are more accurate as they measure the elimination process of a substance that is cleared and/or metabolized almost exclusively by the liver. However, these tests only measure global liver function. Nuclear imaging techniques ((99m)Tc-galactosyl serum albumin scintigraphy and (99m)Tc-mebrofenin hepatobiliary scintigraphy) can measure both total and future remnant liver function and potentially identify patients at risk for postresectional liver failure.
CONCLUSIONS
Because of the complexity of liver function, one single test does not represent overall liver function. In addition to computed tomography volumetry, quantitative liver function tests should be used to determine whether a safe resection can be performed. Presently, (99m)Tc-mebrofenin hepatobiliary scintigraphy seems to be the most valuable quantitative liver function test, as it can measure multiple aspects of liver function in, specifically, the future remnant liver.
Topics: Biomarkers; Coloring Agents; Cone-Beam Computed Tomography; Health Status Indicators; Hepatectomy; Humans; Indocyanine Green; Liver; Liver Failure; Liver Function Tests; Patient Selection; Postoperative Complications; Preoperative Care; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon
PubMed: 22836216
DOI: 10.1097/SLA.0b013e31825d5d47 -
Gut Jan 2018These updated guidelines on the management of abnormal liver blood tests have been commissioned by the Clinical Services and Standards Committee (CSSC) of the British...
These updated guidelines on the management of abnormal liver blood tests have been commissioned by the Clinical Services and Standards Committee (CSSC) of the British Society of Gastroenterology (BSG) under the auspices of the liver section of the BSG. The original guidelines, which this document supersedes, were written in 2000 and have undergone extensive revision by members of the Guidelines Development Group (GDG). The GDG comprises representatives from patient/carer groups (British Liver Trust, Liver4life, PBC Foundation and PSC Support), elected members of the BSG liver section (including representatives from Scotland and Wales), British Association for the Study of the Liver (BASL), Specialist Advisory Committee in Clinical Biochemistry/Royal College of Pathology and Association for Clinical Biochemistry, British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN), Public Health England (implementation and screening), Royal College of General Practice, British Society of Gastrointestinal and Abdominal Radiologists (BSGAR) and Society of Acute Medicine. The quality of evidence and grading of recommendations was appraised using the AGREE II tool. These guidelines deal specifically with the management of abnormal liver blood tests in children and adults in both primary and secondary care under the following subheadings: (1) What constitutes an abnormal liver blood test? (2) What constitutes a standard liver blood test panel? (3) When should liver blood tests be checked? (4) Does the extent and duration of abnormal liver blood tests determine subsequent investigation? (5) Response to abnormal liver blood tests. They are not designed to deal with the management of the underlying liver disease.
Topics: Algorithms; Biomarkers; Chemical and Drug Induced Liver Injury; Disease Management; Evidence-Based Medicine; Humans; Liver Diseases; Liver Function Tests; Non-alcoholic Fatty Liver Disease; Risk Factors
PubMed: 29122851
DOI: 10.1136/gutjnl-2017-314924 -
World Journal of Gastroenterology Dec 2014Liver cirrhosis is a common and growing public health problem globally. The diagnosis of cirrhosis portends an increased risk of morbidity and mortality. Liver biopsy is... (Review)
Review
Liver cirrhosis is a common and growing public health problem globally. The diagnosis of cirrhosis portends an increased risk of morbidity and mortality. Liver biopsy is considered the gold standard for diagnosis of cirrhosis and staging of fibrosis. However, despite its universal use, liver biopsy is an invasive and inaccurate gold standard with numerous drawbacks. In order to overcome the limitations of liver biopsy, a number of non-invasive techniques have been investigated for the assessment of cirrhosis. This review will focus on currently available non-invasive markers of cirrhosis. The evidence behind the use of these markers will be highlighted, along with an assessment of diagnostic accuracy and performance characteristics of each test. Non-invasive markers of cirrhosis can be radiologic or serum-based. Radiologic techniques based on ultrasound, magnetic resonance imaging and elastography have been used to assess liver fibrosis. Serum-based biomarkers of cirrhosis have also been developed. These are broadly classified into indirect and direct markers. Indirect biomarkers reflect liver function, which may decline with the onset of cirrhosis. Direct biomarkers, reflect extracellular matrix turnover, and include molecules involved in hepatic fibrogenesis. On the whole, radiologic and serum markers of fibrosis correlate well with biopsy scores, especially when excluding cirrhosis or excluding fibrosis. This feature is certainly clinically useful, and avoids liver biopsy in many cases.
Topics: Animals; Biomarkers; Biopsy; Diagnostic Imaging; Elasticity Imaging Techniques; Humans; Liver; Liver Cirrhosis; Liver Function Tests; Predictive Value of Tests; Prognosis
PubMed: 25492996
DOI: 10.3748/wjg.v20.i45.16820 -
RoFo : Fortschritte Auf Dem Gebiete Der... Oct 2015Preoperative assessment of liver function and prediction of postoperative functional reserve are important in patients scheduled for liver resection. While determination... (Review)
Review
UNLABELLED
Preoperative assessment of liver function and prediction of postoperative functional reserve are important in patients scheduled for liver resection. While determination of absolute liver function currently mostly relies on laboratory tests and clinical scores, postoperative remnant liver function is estimated volumetrically using imaging data obtained with computed tomography (CT) or magnetic resonance imaging (MRI). Accurate estimation of hepatic function is also relevant for intensive care patients, oncologic patients, and patients with diffuse liver disease. The indocyanine green (ICG) test is still the only established test for estimating true global liver function. However, more recent tools such as the LiMAx test also allow global assessment of hepatic function. These tests are limited when liver function is inhomogeneously distributed, which is the case in such conditions as unilateral cholestasis or after portal vein embolization. Imaging-based liver function tests were first developed in nuclear medicine and, compared with laboratory tests, have the advantage of displaying the spatial distribution of liver function. Nuclear medicine scans are obtained using tracers such as 99mTc galactosyl and 99mTc mebrofenin. Liver function is typically assessed using planar scintigraphy. However, three-dimensional volumetry is possible with single-photon emission computed tomography (SPECT-CT). Another technique for image-based liver function estimation is Gd-EOB-enhanced MRI. While metabolization of Gd-EOB in the body is similar to that of ICG and mebrofenin, its distribution in the liver can be displayed by MRI with higher temporal and spatial resolution. Moreover, MRI-based determination of liver function can be integrated into routine preoperative imaging. This makes MRI an ideal candidate for preoperative determination of liver function, though the best pulse sequence and the parameter to be derived from the image information remain to be identified. Another question to be answered is how the results may be affected by renal function and the presence of hyperbilirubinemia. As more results from clinical evaluation including comparison with postoperative liver function data become available, image-based liver function tests, especially with use of Gd-EOB as the contrast medium, have the potential to add another dimension to preoperative imaging.
KEY POINTS
Liver function consists of a multitude of subfunctions such as biotransformation, excretion and storage. Global liver function tests are score-based tests such as Child-Pugh or MELD as well as the ICG- and LiMAx-test. Imaging-based liver function tests add spatial information. Current clinical standard is the 99mTc-Mebrofenin-scintigraphy. MRI-based function tests with Gd-EOB-DTPA have the potential to integrate seamlessly into clinical workup, feature a higher temporal and spatial resolution and do not rely on ionizing radiation.
Topics: Contrast Media; Diagnostic Imaging; Hepatectomy; Humans; Liver Function Tests; Organ Size; Postoperative Complications; Preoperative Care
PubMed: 26230140
DOI: 10.1055/s-0035-1553306 -
Journal of Hepatology Mar 2022Non-alcoholic steatohepatitis (NASH) is a chronic, progressive fibrotic liver disease that can lead to cirrhosis. While liver biopsy is considered the reference standard...
BACKGROUND & AIMS
Non-alcoholic steatohepatitis (NASH) is a chronic, progressive fibrotic liver disease that can lead to cirrhosis. While liver biopsy is considered the reference standard for the histologic diagnosis of NASH and staging of fibrosis, its use in clinical practice is limited. Non-invasive tests (NITs) are increasingly being used to identify and stage liver fibrosis in patients with NASH, and several can assess liver-related outcomes. We report changes in various NITs in patients treated with obeticholic acid (OCA) or placebo in the phase III REGENERATE study.
METHODS
Patients with NASH and fibrosis stage F2 or F3 (n = 931) were randomized (1:1:1) to receive placebo, OCA 10 mg, or OCA 25 mg once daily. Various NITs based on clinical chemistry and/or imaging were evaluated at baseline and throughout the study.
RESULTS
Rapid, sustained reductions from baseline in alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyltransferase levels, as well as in Fibrosis-4 (FIB-4), FibroTest, FibroMeter, and FibroScan-AST scores were observed in OCA-treated vs. placebo-treated patients. Reduction in liver stiffness by vibration-controlled transient elastography was observed in the OCA 25 mg group vs. the placebo group at Month 18. NIT changes were associated with shifts in histologic fibrosis stage. The greatest improvements were observed in patients with ≥1-stage fibrosis improvement; however, improvements in ALT, AST, FIB-4, and FibroTest were also observed in OCA-treated patients whose histologic fibrosis remained stable.
CONCLUSIONS
Based on the REGENERATE Month 18 interim analysis, rapid and sustained improvements in various NITs were observed with OCA treatment. Dynamic changes in selected NITs separated histologic responders from non-responders. These results suggest that NITs may be useful in assessing histologic response to OCA therapy. CLINICALTRIALS.
GOV NUMBER
NCT02548351 LAY SUMMARY: Non-alcoholic steatohepatitis (NASH) is a chronic, progressive liver disease that can lead to cirrhosis. To diagnose and assess liver fibrosis (scarring) in patients with NASH, non-invasive tests (NITs) are increasingly being used rather than liver biopsy, which is invasive, expensive, and can be risky. In the REGENERATE study, which is evaluating the effects of obeticholic acid vs. placebo in patients with NASH, various NITs were also evaluated. This analysis shows that improvements in levels of certain blood components, as well as favorable results of ultrasound imaging and proprietary tests of liver function, were associated with improvements in liver fibrosis after treatment with obeticholic acid, suggesting that NITs may be useful alternatives to liver biopsy in assessing NASH patients' response to therapy.
Topics: Adult; Aged; Chenodeoxycholic Acid; Double-Blind Method; Female; Humans; Liver; Liver Cirrhosis; Liver Function Tests; Logistic Models; Male; Middle Aged; Non-alcoholic Fatty Liver Disease; Placebos
PubMed: 34793868
DOI: 10.1016/j.jhep.2021.10.029 -
Journal of Viral Hepatitis Jan 2023
Topics: Humans; COVID-19; Liver Function Tests; Liver Diseases; Liver
PubMed: 36369662
DOI: 10.1111/jvh.13772 -
JPMA. the Journal of the Pakistan... Mar 2021To determine whether C-reactive protein and liver function tests can serve as severity markers for dengue fever.
OBJECTIVE
To determine whether C-reactive protein and liver function tests can serve as severity markers for dengue fever.
METHODS
The cross-sectional study was conducted in 2015-16 in Karachi and comprised patients with dengue fever visiting a tertiary care hospital. World Health Organisation classifications 1997 and 2009 were used to categorise patients according to clinical signs and symptoms. Receiver Operating Characteristics curve was used to determine discriminative ability and optimum cut-off value of biochemical markers. Comparisons were done through one-way analysis of variance using SPSS 17.
RESULTS
Of the 218 patients, 133(61%) were males and 85(39%) were females. The overall mean age was 35.07±15.96 years. Levels of C-reactive protein and total bilirubin were significantly higher for dengue haemorrhagic fever compared to dengue fever; dengue shock syndrome compared to dengue fever; dengue shock syndrome compared to dengue haemorrhagic fever; and dengue shock syndrome compared to dengue fever / dengue haemorrhagic fever (p<0.05 each). Levels of alanine aminotransferase, aspartate aminotransferase and alkaline phosphatase were significantly higher for dengue shock syndrome compared to dengue fever; dengue shock syndrome compared to dengue haemorrhagic fever; and dengue shock syndrome compared to dengue fever / dengue haemorrhagic fever (p<0.05 each). Levels of C-reactive protein, total bilirubin, alanine aminotransferase and alkaline phosphatise in patients with severe dengue were significantly higher compared to non-severe dengue.
CONCLUSIONS
C-reactive protein and liver function tests were found to be effective biochemical markers in assessing dengue fever severity.
Topics: Adult; Aspartate Aminotransferases; C-Reactive Protein; Cross-Sectional Studies; Dengue; Female; Humans; Liver Function Tests; Male
PubMed: 34057926
DOI: 10.47391/JPMA.170 -
Archives of Disease in Childhood Sep 1984
Topics: Chemical and Drug Induced Liver Injury; Child; Epilepsy; Humans; Liver Diseases; Liver Function Tests; Valproic Acid
PubMed: 6435543
DOI: 10.1136/adc.59.9.813 -
Taiwanese Journal of Obstetrics &... Oct 2015Deranged liver function tests are encountered in 3% of pregnancies. The potential causes are classified as those unique to and those just incidental to pregnancy.... (Review)
Review
Deranged liver function tests are encountered in 3% of pregnancies. The potential causes are classified as those unique to and those just incidental to pregnancy. Pregnancy-related diseases are the most frequent causes of liver dysfunction during pregnancy and exhibit a trimester-specific occurrence during pregnancy. Differentiation of liver dysfunction as that related to and just incidental to pregnancy is the key to management, especially when liver dysfunction is encountered after 28 weeks of pregnancy. It can be judged from the fact that delivery remains the cornerstone of management of pregnancy-related diseases except hyperemesis gravidarum. This is an overview of the causes of liver dysfunction during pregnancy; an update on the underlying mechanisms of their occurrence, especially liver diseases unique to pregnancy; and a methodological approach to their diagnosis and management.
Topics: Disease Management; Female; Global Health; Humans; Incidence; Liver Diseases; Liver Function Tests; Pregnancy; Pregnancy Complications; Prognosis
PubMed: 26522095
DOI: 10.1016/j.tjog.2015.01.004 -
British Medical Journal Apr 1954
Topics: Humans; Liver; Liver Function Tests
PubMed: 13149874
DOI: 10.1136/bmj.1.4867.927