Aminopyrine Breath Test in the Prognostic Evaluation of Patients with Cirrhosis

Abstract

This prospective study assessed the role of aminopyrine breath test in the prognosis of patients with cirrhosis, and evaluated whether the test provided useful information not included in the Pugh score. During a period of 36 months, 125 patients with biopsy proven liver cirrhosis were included, and followed for up to 48 months (median 17 months). During follow up 43 patients died (20 of liver failure). Survival was univariately related to aminopyrine breath test (p<002), Pugh score (p<0.01), presence of ascites (p<0.01), and sex (p<0.05). Using Cox's regression analysis, Pugh score, aminopyrine breath test, and sex, were independent significant predictors of survival. From the Cox's model a prognostic index was computed. According to a receiver operating characteristic curve analysis, the prognostic index predicting death showed an improvement in area under the curve when compared with a prognostic index calculated excluding aminopyrine breath test, but the improvement did not reach statistical significance (p=0.12). A similar prognostic index was calculated to predict death from liver failure. Cox's regression analysis selected aminopyrine breath test, Pugh score, and aetiology as the best set of predictor covariates. According to a receiver operating characteristic curve analysis, a prognostic index cut off value of 2-6 had a 94% sensitivity and a 88% specificity. The prognostic index significantly improved prognostic accuracy when compared with a prognostic index calculated from Pugh score and aetiology, but excluding aminopyrine breath test (p=0.05). These data disclose that the aminopyrine breath test offers additional prognostic information to the Pugh score, and it may become a useful tool to better assess the prognosis of patients with cirrhosis.

13C-Aminopyrine breath test accurately predicts long-term outcome of chronic hepatitis C

“…In these cases, 13 C-ABT has been demonstrated to reliably predict histological severity, clinical improvement and short-term survival more than conventional liver function tests. Similarly, in patients with cirrhosis, the addition of 13 C-ABT significantly improved the prognostic stratification of the MELD and Child-Pugh score and, therefore, the estimation of the outcome of the disease [32][33][34]. In patients with HCV-related chronic liver disease, 13 C-ABT has been demonstrated to be useful to evaluate only the severity of disease but not the risk of disease progression.…”

Natural history and prognostic indicators of survival in cirrhosis: A systematic review of 118 studies

“…Only one study fulfilled all quality criteria [39]. Thirty-one studies met our criteria for a 'good' quality study [32,37,39,47,55,57,60,62,63,66,76,81,85,89,92,[95][96][97]100,103,104,112,116,117,123,124,128,130,138,142,143]. …”

Assessment of the prognosis of cirrhosis: Child–Pugh versus MELD

“…Interestingly, the prognostic information provided by the addition of different markers of liver metabolism (such as the elimination of galactose, ICG, aminopyrine, or lidocaine) to the variables of Child-Pugh score is limited [23][24][25][26]. Similarly, the addition of usual anthropometric markers of nutritional status does not seem to add much to the predictive value of Child-Pugh score [4].…”

“…For instance, the weight of creatinine is more than twice as high as that of bilirubin in MELD score [32]. Other studies have shown that markers of portal hypertension including oesophageal varices [34], portal blood velocity [35] and hepatic venous pressure gradient [24] provide additional prognostic information when added to the variables of Child-Pugh score.…”