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Prognostic value of galactose elimination capacity, aminopyrine breath test, and ICG clearance in patients with cirrhosis

Comparison with the pugh score

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Abstract

Seventy-eight patients with cirrhosis were prospectively followed for up to 20 months, on the average. At entry into the study, galactose elimination capacity, aminopyrine breath test, and ICG clearance were measured. At the end of the study, 27 patients had died. Univariate analysis using the Kaplan-Meier method showed that both quantitative liver function tests (galactose elimination capacity:P<0.025; aminopyrine breath test:P<0.001; ICG clearance:P<0.005) and common clinical and biochemical data (encephalopathy:P<0.001; ascites:P<0.001; serum bilirubin:P<0.005; serum albumin:P<0.001; prothrombin index:P<0.05) were significant predictors of survival. To investigate whether quantitative liver function tests could contribute to a better definition of the prognosis, once Pugh score had already been taken into account, a multiple regression analysis according to the Cox model was performed. Pugh score and galactose elimination capacity resulted in the only independent prognostic covariates. From them a prognostic index was calculated, and the model was validated in an additional sample of 70 patients investigated according to the same protocol. The contribution GEC gave to the assessment of overall prognosis over that obtained using the Pugh score was slight, as estimated by the statistical parameters of the Cox's model, but was significant as assessed by a ROC curve analysis (P=0.05). These data show that all quantitative liver function tests were predictors of survival in cirrhosis, and that the galactose elimination capacity added some new prognostic information to those already available using the Child-Turcotte-Pugh classification.

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References

  1. Orrego H, Israel Y, Blake JE, Medline A: Assessments of prognostic factors in alcoholic liver disease: Towards a global quantitative expression of severity. Hepatology 3:896–905, 1983

    Google Scholar 

  2. Schlichting P, Christensen E, Andersen PK, Fauerholdt L, Juhl E, Poulsen H, Tygstrup N, Copenhagen Study Group for Liver Diseases: Prognostic factors in cirrhosis identified by Cox's regression model. Hepatology 3:889–895, 1983

    Google Scholar 

  3. Pignon JP, Poynard T, Naveau S, Marteau P, Zourabichvili O, Chaput JC: Analyse multidimensionnelle selon le modele de Cox de la survie de patients atteints de cirrhose alcolique. Gastroenterol Clin Biol 10:461–467, 1986

    Google Scholar 

  4. D'Amico G, Morabito A, Pagliaro L, Marubini E, Liver Study Group of “V Cervello” Hospital: Survival and prognostic indicators in compensated and decompensated cirrhosis. Dig Dis Sci 31:468–475, 1986

    Google Scholar 

  5. Rossi L, Milani A, Marra L, Siciliano M: Grading scores and survivorship functions in liver cirrhosis: A comparative statistical analysis of various predictive models. Hepato-Gastroenterol 33:240–243, 1986

    Google Scholar 

  6. Saunders JB, Wright N, Lewis KO: Predicting outcome of paracetamol poisoning by using 14-C-aminopyrine breath test. Br Med J 280:279–280, 1980

    Google Scholar 

  7. Schneider JF, Baker AL, Haines NW, Hatfield G, Boyer JL: AminopyrineN-demethylation: A prognostic test of liver function in patients with alcoholic liver disease. Gastroenterology 79:1145–1150, 1980

    Google Scholar 

  8. Ranek L, Andreasen PB, Tygstrup N: Galactose elimination capacity as a prognostic index in patients with fulminant liver failure. Gut 17:959–963, 1976

    Google Scholar 

  9. Henry DA, Kitchingman G, Langman MJS: [14C]aminopyrine breath analysis and conventional biochemical tests as predictors of survival in cirrhosis. Dig Dis Sci 30:813–818, 1985

    Google Scholar 

  10. Lindskov J: The quantitative liver function as measured by the galactose elimination capacity. II Prognostic value and changes during disease in patients with cirrhosis. Acta Med Scand 175:291–300, 1964

    Google Scholar 

  11. Rasmussen B, Dossing M, Poulsen HE, Tygstrup N: Antipyrine, aminopyrine and s-bilirubin as prognostic indices of five years survival in liver cirrhosis. J Hepatol 5:S189, 1987 (abstract)

    Google Scholar 

  12. Adler M, Van Laethem J, Glibert A, Gelin M, Bourgeois N, Vereerstraeten P, Cremer M: Factors influencing survival at one year in patients with nonbiliary hepatic parenchymal cirrhosis. Dig Dis Sci 35:1–5, 1990

    Google Scholar 

  13. Pugh RNH, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R: Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 60:646–649, 1973

    Google Scholar 

  14. Villeneuve JP, Infante-Rivard C, Ampelas M, Pomier-Layrargues G, Huet PM, Marleau D: Prognostic value of the aminopyrine breath test in cirrhotic patients. Hepatology 6:928–931, 1986

    Google Scholar 

  15. Albers I, Hartmann H, Bircher L, Creutzfeld W: Superiority of the Child-Pugh classification to quantitative liver function tests for assessing prognosis of liver cirrhosis. Scand J Gastroenterol 24:269–276, 1989

    Google Scholar 

  16. Hepner GW, Vesell ES: Quantitative assessment of hepatic function by breath analysis after oral administration of 14-C-aminopyrine. Ann Intern Med 83:632–638, 1975

    Google Scholar 

  17. Tygstrup N: Determination of the hepatic elimination capacity (Lm) of galactose by single injection. Scand J Clin Lab Invest 18(suppl):118–125, 1966

    Google Scholar 

  18. Villeneuve JP, Huet R, Marleau D, Huet PM: The estimation of hepatic blood flow with indocyanine green: Comparison between the continuous infusion and the single injection methods. Am J Gastroenterol 77:233–237, 1982

    Google Scholar 

  19. Merkel C, Sacerdoti D, Finucci GF, zuin R, Bazzerla G, Bolognesi M, Gatta A: Effect of nadolol on liver haemodynamics and function in patients with cirrhosis. Br J Clin Pharmacol 21:713–719, 1986

    Google Scholar 

  20. Kaplan EL, Meier P: Nonparametric estimation from incomplete observations. J Am Stat Assoc 53:457–481, 1958

    Google Scholar 

  21. Mantel N, Haenzel W: Statistical aspects of the analysis of data from retrospective studies of diseases. J Natl Cancer Inst 22:719–748, 1959

    Google Scholar 

  22. Peto R, Pike MC, Armitage P, Breslow NE, Cox DR, Howard SV, Mantel N, McPherson K, Peto J, Smith PG: Design and analysis of randomized clinical trials requiring prolonged observation of each patients. Analysis and examples. Br J Cancer 35:1–39, 1977

    Google Scholar 

  23. Cox DR: Regression models and life-tables. J R Stat Soc 34:187–220, 1972

    Google Scholar 

  24. Beale EML, Little RJA: Missing values in multivariate analysis. J R Stat Soc B 37:129–145, 1975

    Google Scholar 

  25. Infante-Rivard C, Villeneuve JP, Esnaola S: A framework for evaluating and conducting prognostic studies: An application to cirrhosis of the liver. J Clin Epidemiol 42:791–805, 1989

    Google Scholar 

  26. Infante-Rivard C, Esnaola S, Villeneuve JP: Clinical and statistical validity of conventional prognostic factors in predicting short-term survival among cirrhotics. Hepatology 7:660–664, 1987

    Google Scholar 

  27. Hanley JA, McNeil BJ: The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 143:29–36, 1982

    Google Scholar 

  28. Hanley JA, McNeil BJ: A method of comparing the areas under receiver operating characteristic curve derived from the same cases. Radiology 148:839–843, 1983

    Google Scholar 

  29. Dixon WJ, Brown MB, Engelman L, Frane JW, Hill MA, Jenrich RI, Toporek JD: BMDP Statistical software. Berkeley, University of California Press, 1983

    Google Scholar 

  30. Christensen E, Schlichting P, Fauerholdt L, Gluud C, Andersen PK, Juhl E, Poulsen H, Tygstrup N, Copenhagen Study Group for Liver Diseases: Prognostic value of Child-Turcotte criteria in medically treated cirrhosis. Hepatology 4:430–435, 1984

    Google Scholar 

  31. Gluud C, Henriksen JH, Nielsen G, Copenhagen Study Group for Liver Diseases: Prognostic indicators in alcoholic cirrhotic men. Hepatology 8:222–227, 1988

    Google Scholar 

  32. Bircher J, Kuepfer A, Gikalov I, Preisig G: Aminopyrine demethylation measured by breath analysis in cirrhosis. Clin Pharmacol Ther 20:484–492, 1976

    Google Scholar 

  33. Merkel C, Gatta A, Milani L, Bolognesi M, Sacerdoti D, Bazzerla G, Zuin R: Relationships between hepatic metabolism of indocyanine green, galactose, and dimethylaminopyrine in liver cirrhosis: A confirmation of the intact hepatocyte hypothesis. J Hepatol 1(suppl):92, 1985 (abstract)

    Google Scholar 

  34. Keiding S, Andreasen PB, Fauerholdt L: Effect of phenobarbital induction on galactose elimination capacity in rat liver. Biochem Pharmacol 22:2293–2299, 1973

    Google Scholar 

  35. Black KA, Virayotha V, Telphly TR: Reduction of hepatic tetrahydro-folate and inhibition of exalation of14CO2 formed from [dimethylamino-14C]aminopyrine in liver diseases. Dig Dis Sci 4:871–876, 1982

    Google Scholar 

  36. Keiding S: Hepatic clearance and liver blood flow. J Hepatol 4:393–398, 1987

    Google Scholar 

  37. Gross JB, Reichen J, Zeltner TB, Zimmermann A: The evolution of changes in quantitative liver function tests in a rat model of biliary cirrhosis: Correlation with morphometric measurement of hepatocyte mass. Hepatology 7:457–463, 1987

    Google Scholar 

  38. Merkel C, Bolognesi M, Bellon S, Bianco S, Honisch B, Lampe H, Angeli P, Gatta A: Aminopyrine breath test improves prognostic ability of Pugh score in patients with cirrhosis. (Abstract). International Association for the Study of the Liver, September 2–5, 1990 (abstract 80)

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Authors and Affiliations

  1. Istituto di Medicina Clinica, Cattedra di Clinica Medica II, Policlinico Universitario, Università di Padova, via Giustiniani, 2, I-35100, Padova, Italy

    Carlo Merkel MD, Angelo Gatta MD, Marco Zoli MD, Massimo Bolognesi MD, Paolo Angeli MD, Tiziana Iervese MD, Giulio Marchesini MD & Arturo Ruol MD

  2. Istituto di Clinica Medica Generale, Università di Bologna, Italy

    Carlo Merkel MD, Angelo Gatta MD, Marco Zoli MD, Massimo Bolognesi MD, Paolo Angeli MD, Tiziana Iervese MD, Giulio Marchesini MD & Arturo Ruol MD

Authors
  1. Carlo Merkel MD
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  2. Angelo Gatta MD
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  3. Marco Zoli MD
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  4. Massimo Bolognesi MD
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  5. Paolo Angeli MD
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  6. Tiziana Iervese MD
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  7. Giulio Marchesini MD
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  8. Arturo Ruol MD
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Additional information

This study was supported in part by a grant from the Italian Ministry of Education (National Project ‘Liver Cirrhosis’). Part of this study was presented at the 22nd Meeting of the European Society for Clinical Investigation, Graz, Austria, April 20–23, 1988.

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Merkel, C., Gatta, A., Zoli, M. et al. Prognostic value of galactose elimination capacity, aminopyrine breath test, and ICG clearance in patients with cirrhosis. Digest Dis Sci 36, 1197–1203 (1991). https://doi.org/10.1007/BF01307508

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  • DOI: https://doi.org/10.1007/BF01307508

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