Evaluation of hepatic function in liver cirrhosis - Clinical utility of galactose elimination capacity, hepatic clearance of D-sorbitol, and laboratory investigations

Assessment of hepatic function is based on both liver blood tests and funct ional tests, the extensive application of which is still controversial. The aim of this study was to evaluate the clinical utility of a few selected t ests as discriminatory and prognostic indexes: serum albumin, pseudocholine sterase, prothrombin time, as well as galactose elimination capacity and he patic sorbitol clearance. Two separate studies were performed: Study I to i nvestigate how well these tests assessed severity, and Study II to evaluate their prognostic value. A total of 128 consecutive cirrhotic patients clas sified according to the Child-Pugh score were included in Study I; Study II was carried out on 47 of these 128 during a two-year follow-up period. Pai rwise correlations between all tests and Child-Pugh score yielded higher si gnificant values for liver blood tests than for the functional ones. In Stu dy I functional tests such as galactose elimination capacity and hepatic so rbitol clearance did not appear to be batter than conventional biochemical tests in discriminating clinical severity of cirrhotic patients, as defined by Child-Pugh classification. Results of Study II confirmed that in severe liver cirrhosis Child-Pugh score remains the best method for medium- and l ong-term prognosis and for planning liver transplantation. Functional tests should be reserved for defining the residual functioning liver mass or for studies about functional liver plasma flow.