Aminopyrine breath test in the prognostic evaluation of patients with cirrhosis.

Merkel, Carlo; Bolognesi, Massimo; Bellon, S.; Bianco, Simone; Honisch, B.; Lampe, H. B.; Angeli, Paolo; Gatta, Angelo

doi:10.1136/gut.33.6.836

Cited by 89 publications

(41 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In terms of prognostication, studies have shown that these tests offer little, if any, additional predictive information when compared with more traditional assessment such as the Child-Pugh score. [23][24][25][26][27] The results from the present study support the application of the CBT as a test of quantitative liver assessment. Our data indicate that: (1) the elimination of caffeine is impaired in cirrhosis, characterized by a reduction in plasma clearance and a prolongation in caffeine half-life; (2) the oral 13 C-CBT using a single 1-hour measure correlates very closely with plasma caffeine clearance; (3) cirrhotic subjects show significantly reduced CBT results compared with control and hepatitic subjects; (4) CBT values are increased in smokers but still distinguish smokers of varying hepatic functional impairment; (5) the CBT appears to be a reproducible assay; and, (6) the CBT is administered easily and safely in subjects with liver disease.…”

Section: Discussionsupporting

confidence: 55%

Validity of the 13C-caffeine breath test as a noninvasive, quantitative test of liver function

Park

2003

Hepatology

View full text Add to dashboard Cite

The properties of caffeine render it an ideal substrate for a quantitative test of liver function. The aim of this study was to determine whether the caffeine breath test (CBT) using orally administered 13 C-caffeine correlates reliably with plasma caffeine clearance and reflects varying degrees of liver dysfunction. The CBT was performed in 25 healthy controls; 20 subjects with noncirrhotic, chronic hepatitis B or C; and 20 subjects with cirrhosis. Plasma caffeine clearance was assayed simultaneously with the CBT in a cohort of these subjects. Over a broad range of caffeine clearances, the CBT exhibited a highly significant correlation with plasma clearance (r ‫؍‬ 0.85, P < .001). Cirrhotic patients were characterized by significantly reduced CBT values (1.15 ؎ 0.75 ‚‰ mg ؊1 ) compared with controls (2.23 ؎ 0.76; P ‫؍‬ .001) and hepatitic patients (1.83 ؎ 1.05; P ‫؍‬ .04). There was a significant inverse relationship between the CBT and Child-Pugh score (r ‫؍‬ ؊.74, P ‫؍‬ .002). The intraclass correlation coefficient between repeated CBTs in 20 subjects with normal and cirrhotic livers was 0.89. Although smoking was associated with an 86% to 141% increase in CBT in all groups, the CBT was able to distinguish control, hepatitic, and cirrhotic smokers (5.36 ؎ 0.82, 3.63 ؎ 1.21, and 2.14 ؎ 1.14, respectively, P ‫؍‬ .001). Multivariate analysis revealed that only smoking (P < .001) and disease state (P ‫؍‬ .001) were significant predictors of the CBT. In conclusion, the 13 C-CBT represents a valid indicator of plasma caffeine clearance and correlates reproducibly with hepatic dysfunction. (HEPATOLOGY 2003;38:1227-1236

show abstract

Section: Discussionsupporting

confidence: 55%

Validity of the 13C-caffeine breath test as a noninvasive, quantitative test of liver function

Park

2003

Hepatology

View full text Add to dashboard Cite

show abstract

“…16 The cut-off levels for the most important parameters are listed in Table 1. For ALT, three different cut-off levels were used: the upper limit of normal set by the biochemistry laboratory (56 IU l À1 ), the classical cut-off of 40 IU l À124 and the limits proposed by Prati et al 25 (30 IU l À1 in men, 19 IU l À1 in women).…”

Section: Methodsmentioning

confidence: 99%

“…14 The liver specific program, approved by the Ethics Committee of the University Hospital Antwerp, includes additional blood analysis to exclude the classical etiologies of liver disease (for example, viral hepatitis and autoimmune disease); a Doppler ultrasound of the abdomen; a liver-spleen scintigraphy 15 and an aminopyrine breath test as a measure for liver metabolic reserve. 16 As liver steatosis seems to be closely related to the metabolic syndrome (MS), 17 features of the MS were specifically recorded. According to the US Third Adult Treatment Panel of the National Cholesterol Education Program, 18 the MS is defined as the presence of three or more out of the five known criteria.…”

Section: Methodsmentioning

confidence: 99%

“…Abbreviations: ABT, aminopyrine breath test; ALP, alkaline phophatase; ALT, alanine aminotransferase; AST, aspartate aminotransferase; GGT, g-glutamyl transpeptidasen, number of patients; ULN, upper limit of normal. The criteria for the biochemical parameters, presence of liver steatosis on ultrasound, 21 the liver volume (based on the craniocaudal diameter measured at the right midclavicular parasagittal section), 23 the liver-spleen scintigraphy 15 and the parameters of the ABT 16 are listed and the % of patients meeting the criteria.…”

Section: Ms and Its Criteriamentioning

confidence: 99%

See 1 more Smart Citation

Visceral adiposity and insulin resistance are independent predictors of the presence of non-cirrhotic NAFLD-related portal hypertension

et al. 2010

View full text Add to dashboard Cite

Introduction: We previously demonstrated in an animal model that steatosis, in the absence of fibrosis, induces a significant rise in portal pressure, indicating substantial changes in liver hemodynamics. As assessment of portal pressure is an invasive procedure, non-invasive parameters are needed to identify patients at risk. Aims: To study the portal pressure in nonalcoholic fatty liver disease patients and to identify factors that are possibly related to steatosis-induced changes in liver hemodynamics. Materials and methods: Patients presenting with a problem of overweight or obesity, and in whom non-invasive investigations showed signs of liver involvement, were proposed for transjugular hepatic vein catheterization and liver biopsy. The biopsy was scored according to the Nonalcoholic Steatohepatitis Clinical Research Network Scoring System. Results: A total of 50 consecutive patients were studied. Their mean age was 47.9 ± 1.8 years; 31 (62%) were female. Hepatic venous pressure gradient was normal in 36 (72%) and elevated in 14 (28%) patients. The degree of steatosis was the only histological parameter that differed significantly between the two groups (P ¼ 0.016), and was a predictor of the presence of portal hypertension (PHT) in regression analysis (P ¼ 0.010). Comparing normal versus portal hypertensive patients, waist circumference (117 ± 2 versus 128 ± 4 cm, P ¼ 0.005), waist-hip ratio (0.96 ± 0.06 versus 1.04 ± 0.03, P ¼ 0.003), visceral fat (229 ± 15 versus 292 ± 35 cm 2 , P ¼ 0.022), fasting insulin (15.4 ± 1.7 versus 21.8 ± 2.4 mU ml À1 , P ¼ 0.032), fasting c-peptide (1.22 ± 0.06 versus 1.49 ± 0.09 nmol l À1 , P ¼ 0.035) and homeostasis model assessment-insulin resistance (HOMA IR) (3.28 ± 0.29 versus 4.81 ± 0.57, P ¼ 0.019) were significantly higher. Age, gender, liver enzymes, ferritin and high-sensitive C-reactive protein were not significantly different. In regression analysis, waist circumference (P ¼ 0.008) and HOMA IR (P ¼ 0.043) were independent predictors of PHT. Conclusions: Estimates of both visceral adiposity and IR are predictors for the presence of PHT, related to the degree of steatosis, and may help in identifying patients who are at risk of developing steatosis-related complications.

show abstract

“…5 The first risk of death, but, when a time-dependent model was Prentice's criterion is proven by the strict association of defitted containing galactose elimination capacity and per-crease in quantitative liver function tests and survival shown sistent alcohol abuse, only the former remained signifi-in many series. [6][7][8] The adherence to the second criterion is cant. This implies that variations in the risk of death more difficult to prove, and should be assessed for any single occurring as a consequence of abstinence from alcohol treatment.…”

mentioning

confidence: 99%

The course of galactose elimination capacity in patients with alcoholic cirrhosis: Possible use as a surrogate marker for death

et al. 1996

Self Cite

View full text Add to dashboard Cite

ditions and in response to other treatments. (HEPATOLThere is increasing interest for the use of surrogate OGY 1996;24:820-823.) end points in the evaluation of treatments in patients with liver disease, but adequate validation is seldom Recent research in clinical epidemiology focused on the valavailable. This study aimed to describe the different idation of surrogate end points to be used instead of the true, course of galactose elimination capacity in patients with clinically relevant events which need a long time to take alcoholic cirrhosis who continued to drink or abstained place. 1,2 Before a surrogate end point may be used in the from alcohol consumption during follow-up, and to vali-clinical practice, its adequacy must be proven in the clinical date changes in galactose elimination as a surrogate end problem, and with the therapeutic options under study. 3 The point for death from liver-related causes. Forty-five pa-more stringent method to validate a surrogate end point is tients with alcoholic cirrhosis (22 who continued drink-the analysis of a trial or a series of trials performed on the ing throughout the study period, and 23 who stopped clinical problem under study, to verify if (or to what extent) drinking and were abstinent throughout the study pe-the surrogate end point meets the criteria proposed by Prenriod) were retrospectively selected among patients who tice. 4 In particular, the first criterion requests that the occurhad galactose elimination capacity measured at 6-month rence of the surrogate end point is linked to the occurrence intervals. During follow-up 10 drinkers and 3 abstainers of the true end point; the second criterion requests that the died of liver-related causes (P Å .025). Abstainers showed mechanism(s) through which treatment influences the true a transient improvement in galactose elimination capac-end point is directly and at the same time related to the ity, followed by a decrease. Continuous drinkers showed occurrence of the surrogate end point. a reduction from the beginning. According to Cox's rePreliminary data have suggested a possible use of changes gression analyses, persistent alcohol abuse and galac-in quantitative liver function tests as surrogate markers for tose elimination capacity were separately related to the survival in patients with chronic liver disease. 5 The first risk of death, but, when a time-dependent model was Prentice's criterion is proven by the strict association of defitted containing galactose elimination capacity and per-crease in quantitative liver function tests and survival shown sistent alcohol abuse, only the former remained signifi-in many series. [6][7][8] The adherence to the second criterion is cant. This implies that variations in the risk of death more difficult to prove, and should be assessed for any single occurring as a consequence of abstinence from alcohol treatment. Unfortunately, in patients with chronic liver disconsumption may be predicted from changes in galac-ease, the lack of effective treatments improving liver fun...

show abstract

Aminopyrine breath test in the prognostic evaluation of patients with cirrhosis.

Cited by 89 publications

References 25 publications

Validity of the 13C-caffeine breath test as a noninvasive, quantitative test of liver function

Validity of the 13C-caffeine breath test as a noninvasive, quantitative test of liver function

Visceral adiposity and insulin resistance are independent predictors of the presence of non-cirrhotic NAFLD-related portal hypertension

The course of galactose elimination capacity in patients with alcoholic cirrhosis: Possible use as a surrogate marker for death

Contact Info

Product

Resources

About