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      What is the Real Function of the Liver ‘Function’ Tests?

      case-report
      Author(s): ,
      Publication date (Print):
      Journal: The Ulster Medical Journal
      Publisher: The Ulster Medical Society

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          Abstract

          Liver enzymes are commonly used in the evaluation of patients with a range of diseases. Classically they are used to give information on whether a patient’s primary disorder is hepatitic or cholestatic in origin. However, knowledge of enzyme ratios and pattern recognition allow much more information to be derived from these simple tests.

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          Independent predictors of liver fibrosis in patients with nonalcoholic steatohepatitis.

          P Angulo, J Keach, K P Batts … (1999)
          Nonalcoholic steatohepatitis (NASH) may present with increased hepatic fibrosis progressing to end-stage liver disease. No factors that determine increasing fibrosis and histologically advanced disease have been recognized, thus, liver biopsy is recommended in all patients for diagnosis and prognosis. Our aim was to identify independent predictors of severe hepatic fibrosis in patients with NASH. One hundred and forty-four patients were studied. All patients underwent liver biopsy. Clinical and biochemical variables were examined with univariate and multivariate analysis. Thirty-seven (26%) patients had no abnormal fibrosis, 53 (37%) had mild fibrosis, 15 (10%) had moderate fibrosis, 14 (10%) had bridging fibrosis, and 25 (17%) had cirrhosis. In multivariate analysis, older age (P =. 001), obesity (P =.002), diabetes mellitus (P =.009), and aspartate transaminase/alanine transaminase (AST/ALT) ratio greater than 1 (P =.03) were significant predictors of severe liver fibrosis (bridging/cirrhosis). Body mass index (P =.003) was the only independent predictor of the degree of fat infiltration. Increased transferrin saturation correlated positively with the severity of fibrosis (P =.02) in univariate analysis, and there was a trend for more female patients among those with more advanced fibrosis (P =. 09). However, iron studies or gender were not significant when controlled for age, obesity, diabetes, and AST/ALT ratio. In conclusion, older age, obesity, and presence of diabetes mellitus help identify those NASH patients who might have severe liver fibrosis. This is the subgroup of patients with NASH who would be expected to derive the most benefit from having a liver biopsy and considering investigational therapies.
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            International Autoimmune Hepatitis Group Report: review of criteria for diagnosis of autoimmune hepatitis.

            F. Alvarez, P Berg, F B Bianchi … (1999)
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              Development and validation of a simple NAFLD clinical scoring system for identifying patients without advanced disease.

              S Harrison, D. Oliver, H. Arnold … (2008)
              Clinical predictors of advanced non-alcoholic liver disease (NAFLD) are needed to guide diagnostic evaluation and treatment. To better understand the demographics of NAFLD and risk factors for advanced disease, this study analysed 827 patients with NAFLD at two geographically separate tertiary medical centres. The cohort was 51% female and had a median body mass index (BMI) of 33 kg/m(2); 3% had a normal BMI. Common co-morbidities included hypertension (60%) and diabetes (35%); insulin resistance was present in 91% and advanced fibrosis in 24% of patients. When comparing patients with no fibrosis or mild fibrosis to those with advanced fibrosis, BMI > or = 28 kg/m(2), age > 50 years, and aspartate transaminase/alanine aminotransferase (AST/ALT) ratio > or = 0.8, a quantitative assessment check index (QUICKI) score 6.2) and the presence of diabetes mellitus (DM) were individually associated by univariate analysis with odds ratios (ORs) of > or = 2.4 for advanced fibrosis. Based on the results of forced entry logistic regression analysis, three variables were combined in a weighted sum (BMI > or = 28 = 1 point, AAR of > or = 0.8 = 2 points, DM = 1 point) to form an easily calculated composite score for predicting advanced fibrosis called the BARD score. A score of 2-4 was associated with an OR for advanced fibrosis of 17 (confidence interval 9.2 to 31.9) and a negative predictive value of 96%. Insulin resistance and its co-morbidities are often present in patients with NAFLD. An easily calculated score based on readily available clinical data can reliably exclude the presence of advanced fibrosis in these patients, particularly among non-diabetics.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Ulster Med J
                Journal ID (iso-abbrev): Ulster Med J
                Journal ID (publisher-id): umj
                Title: The Ulster Medical Journal
                Publisher: The Ulster Medical Society
                ISSN (Print): 0041-6193
                Publication date (Print): January 2012
                Volume: 81
                Issue: 1
                Pages: 30-36
                Affiliations
                Liver Unit, Royal Victoria Hospital Grosvenor Road, Belfast BT12 6BA
                Author notes
                Correspondence to Dr W. J. Cash Johnny.cash@ 123456belfasttrust.hscni.net
                Article
                PMC ID: 3609680
                PubMed ID: 23536736
                SO-VID: 95b68eed-2705-41ec-b9cd-6e5691853db9
                Copyright © © The Ulster Medical Society, 2012
                History
                Date accepted : 24 August 2011
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Medicine
                Data availability:
                ScienceOpen disciplines: Medicine

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