Decision making in the treatment of patients with severe acute liver disease is currently based on clinical and laboratory parameters. Currently used parameters, including clinical assessment, serum liver enzymes, synthetic tests and serum ammonia levels, lack the ability to accurately assess liver function. Frequent determination of liver function is of importance in the follow-up and management of patients with severe acute liver disease, including those with fulminant hepatic failure. The BreathID® continuous online 13C-methacetin breath test, MBT, enables assessment of the metabolic function of the liver. Aim: To assess the role of the MBT for follow-up in patients with acute liver disease. Methods: 18 patients (9 males and 9 females, ages 18-61) with severe acute liver disease, diagnosed with autoimmune hepatitis (5), acute HAV (2), acute HBV (2), drug-induced liver injury (6), Pregnancy associated (1), Wilson’s Disease (1) and neoplastic disease (1), were followed-up with 13C-MBT during the acute phase of their illness. MBT was performed after an 8-hour fast and ingestion of 75 mg of methacetin.
The correlation between standard follow-up parameters, including clinical assessment, serum liver enzymes, synthetic function, serum ammonia levels and breath test scores including the PDR peak (percentage of 13C dose recovered/hour) , CPDR30 and CPDR60 (cumulative PDR at 30 and 60 minutes, respectively) was assessed. Results: 14 patients recovered and 2 died, no patients were transplanted. In the patients who recovered, clinical improvement and normalization of biochemical parameters were detected by progressive improvement of BreathID® 13C-MBT scores. Evidence of consistent improvement began on day 3 for MBT parameters and between days 7 and 10 for blood tests. Convergence to normality occurred at an average of 9 days for MBT parameters as opposed to 13 to 36 days for blood tests. In both patients who died (autoimmune hepatitis and neoplastic disease), MBT parameters remained low despite fluctuating laboratory values. Conversely, 2 patients with drug induced fulminant hepatic failure despite a MELD of 34-44 and a SOFA score of 12-15 recovered without the need for liver transplantation after showing early improvement in their breath test scores. Overall, breath test parameters showed better correlation with the clinical improvement than all other tests.
Conclusions: The 13C-MBT provides a rapid, non-invasive assessment of liver function in acute severe liver disease of diverse etiologies. Our data suggest that the MBT may offer greater sensitivity than standard clinical tests for managing patients with severe acute liver disease. 1Liver Unit, Department of Medicine, Hebrew University-Hadassah Medical Center, Jerusalem, Israel. 2Liver Intensive Care Unit, King’s College Hospital, London, UK.
Publication information
G Lalazar, T Adar, M Mizrahi, E Zigmond, Y Ilan, AC Chan-Dominy, NJ Taylor, J Wendon (2008) “Follow-up of Patients with Severe Acute Liver Disease Using an On-line 13C-Methacetin Breath Test – A New Tool for Decision Making in Clinical Hepatology” Hepatology 2008; 48(S1) (abstract and conference presentation)