Use of the methacetin breath test to classify the risk of cirrhotic complications and mortality in patients evaluated/listed for liver transplantation
Todd Stravitz R, Reuben A, Mizrahi M, Lalazar G, Brown K, Gordon S, Ilan Y, and Sanyal A. Use of the Methacetin Breath Test to Classify the Risk of Cirrhotic Complications and Mortality in Patients Evaluated/Listed for Liver Transplantation. J Hepatol 2015; 63(6):1345-1351.
Journal of hepatology
BACKGROUND & AIMS: The MELD score predicts short-term mortality in patients with cirrhosis; however, some patients with low scores develop complications and die unexpectedly. Consequently, we evaluated the diagnostic accuracy of the methacetin breath test (MBT), an assay of liver metabolic function, and the MELD score, to predict the risk of complications of cirrhosis and liver-related death.
METHODS: One hundred sixty-five patients with cirrhosis received oral (13)C-methacetin; (13)CO2 was measured in expired breath (BreathID; Exalenz). The cumulative percent dose recovery of (13)CO2 at 20 min with a threshold of ⩽0.55% (high-risk) and >0.55% (low risk) most accurately predicted liver-related death and the risk of cirrhotic complications within one year. MELD thresholds of ⩾15 and ⩾19 were also examined to predict the same endpoints.
RESULTS: Dose recovery ⩽0.55% and MELD ⩾19 both predicted liver-related death (HR 12.6 [95% CI 1.6-98.3]; p=0.016, and HR 5.5 [1.6-18.9]; p=0.007, respectively); MELD ⩾15 did not. Dose recovery ⩽0.55% (HR 1.9 [1.1-3.2]; p=0.03) also predicted the risk of ⩾1 complication(s), and was particularly able to foretell the risk of development/exacerbation of ascites (HR 4.7 [1.8-11.9]; p=0.001), which was not achieved by either MELD threshold. Finally, in patients with MELD
CONCLUSIONS: In this pilot study, methacetin breath testing predicted the risk of liver-related death and development/exacerbation of ascites more accurately than MELD ⩾15 or ⩾19. In patients with low MELD (
Medical Subject Headings
Acetamides; Aged; Ascites; Breath Tests; End Stage Liver Disease; Female; Humans; Liver Cirrhosis; Liver Function Tests; Liver Transplantation; Male; Middle Aged; Pilot Projects; Postoperative Complications; Predictive Value of Tests; Prognosis