Enzymatic liver function measured by LiMAx – a reliable diagnostic and prognostic tool in chronic liver disease

Abstract

Chronic liver disease (CLD) is a major cause of morbidity and mortality worldwide. Non-invasive assessment of hepatic disease severity represents a relevant issue to further improve clinical management and therapeutic treatment. We retrospectively compared the diagnostic and prognostic performance of different non-invasive tools (LiMAx, transient elastography (TE), and biomarkers) in detecting different severity stages during the course of CLD. Patients were divided into four groups based on clinical parameters: (1) patients without CLD (control group), (2) patients suffering from CLD without having cirrhosis, (3) patients with CLD and compensated cirrhosis, and finally, (4) patients with CLD and decompensated cirrhosis. Patients with acute liver failure were excluded from the analysis. A total of 464 patients who underwent LiMAx measurement at the University Clinic of Essen between 10/2016 and 11/2017 were included in this study. Distribution of the different groups were n = 72 patients for group 1, n = 134 patients for group 2, n = 160 patients for group 3, and n = 98 patients for group 4, respectively. Median LiMAx values significantly declined with respect to increasing degree of CLD: (1) 510 µg/h/kg, (2) 390 µg/h/kg, (3) 264 µg/h/kg, and (4) 151 µg/h/kg (p < 0.001). When comparing the diagnostic accuracy of the LiMAx test in detecting patients with presence of cirrhosis (groups 1 and 2 vs. groups 3 and 4), an AUROC of 0.942 was found (cut-off 322 µg/h/kg, sensitivity 86.1%, specificity 91.3%, p < 0.0001). LiMAx was superior to TE and serum biomarkers in predicting patients’ outcome by 90-day mortality (AUROC 0.811, p < 0.001). Enzymatic liver function measured by LiMAx was closely associated with different severity stages of CLD and was a reliable diagnostic and prognostic tool with an accuracy comparable to current standard methods.

Enzymatic liver function measured by LiMAx is superior to current standard methods in predicting transplant-free survival after TIPS implantation

“…Different studies have shown that the LiMAx breath test is able to determine enzymatic liver function and therefore can effectively predict outcome in various clinical settings, like for patients undergoing hepatic surgery or patients with acute liver failure 27 – 30 . In addition, we could demonstrate strong correlation between LiMAx and the degree of chronic liver disease, cirrhosis and portal hypertension in previous studies of our group 32 , 33 . Hence, we evaluated the ability of LiMAx to predict outcome after TIPS placement, in comparison to other, more established parameters.…”

“…The liver maximum capacity (LiMAx) breath test is a novel non-invasive quantitative test to measure enzymatic liver function by determining hepatic metabolization of 13 C-labeled methacetin by cytochrome P450 1A2 and was initially evaluated to assess operability of patients undergoing hepatic surgery 27 – 29 . Still, it was also successfully evaluated for other clinical situations, e. g. estimation of survival of patients with acute liver failure 30 or liver transplant (LT) candidates 31 and for prediction of hepatic disease severity/grade of liver fibrosis 32 , 33 .…”

Surgical Procedures in Patients Awaiting Liver Transplantation: Complications and Impact on the Liver Function

“…LiMAx measurement in patients having surgery while waiting for liver transplantation. 34 It would also be interesting to analyze if surgery and possible complications after surgery have an impact on the likelihood of later successful transplantation.…”

Mitochondria Matter: Systemic Aspects of Nonalcoholic Fatty Liver Disease (NAFLD) and Diagnostic Assessment of Liver Function by Stable Isotope Dynamic Breath Tests

“…Thus, before the examination, the operator should investigate the clinical history to detect symptoms potentially related with altered gastric emptying or conditions affecting the absorption of the substrate from the gastrointestinal tract [ 161 , 162 ]. In this case, the intravenous administration of the substrate (as the LiMAx ® test) can be useful to obtain accurate results, also limiting inter-individual variations in substrate absorption after oral administration [ 163 , 164 , 165 , 166 ].…”