Use of an on-line at the point of care 13C-Methacetin Breath test as an adjunct tool for decision making in patients with Acute Liver Failure

TY - JOUR

T1 - Use of an on-line at the point of care 13C-Methacetin Breath test as an adjunct tool for decision making in patients with Acute Liver Failure

AU - Audimlam, Vinod K.

AU - Patel, Vishal C.

AU - Bernal, William

AU - Mizrahi, Meir

AU - Wendon, Julia

AU - Lalazar, Gadi

AU - Ilan, Yaron

N1 - Publisher: WILEY-BLACKWELL, 111 RIVER ST, HOBOKEN 07030-5774, NJ USA Accession Number: WOS:000310955603266 ISSN: 0270-9139

PY - 2012/10

Y1 - 2012/10

N2 - Optimal management of patients with acute liver failure (ALF) requires timely decision making regarding transplantation (Tx). The sensitivity and specificity of presently utilized clinical, biochemical and hematological parameters vary between transplant centers and could be further improved. The use of blood products masks the coagulation tests further complicating the decision making in these patients. A bedside test that offers real time assessment of liver function may assist decision making and complement the use of standard criteria. The BreathID® continuous online 13C-methacetin breath test (MBT), enables assessment of the metabolic function of the liver at the point of care. Aim: To assess the clinical utility of the MBT in patients with ALF. Methods: Outcome was examined with regard to standard clinical criteria and MBT results. MBT was performed after an 8-hour fast and ingestion of 75 mg of Methacetin. Of the 56 patients recruited to date, 28 fulfilled the established criteria of ALF and had more than one MBT performed throughout the course of their stay in the ICU. The clinical team was blinded to the MBT data. Results: The results of ALF MBT trends in all patients were interpretable. A trend between at least two MBT tests was analyzed in all 28 eligible patients. Trends in PDR peak (percentage of 13C dose recovered/hour), and in CPDR20 (cumulative PDR at 20 minutes) were analyzed for assessment and follow up of the patients and compared with their clinical and laboratory parameters. Two sub-groups of patients were identified: a. 19 of the 28 patients received FFP, which invalidated their INR measurements. In these patients, MBT trends were unaffected by blood products, in such a way as to provide a useful adjunct tool in the decision making in patient management. In patients in who ultimately did not fulfill transplant criteria the early trend in MBT parameters showed improvement . In those who did not fulfill Tx criteria the MBT was in agreement with subsequent outcome. b. Nine of the patients did not receive blood products. The results of MBT trends in these patients were consistent with other ALF measures of severity and supportive of the clinical decisions made. Conclusions: The 13C-MBT provides a rapid, easily applied non-invasive assessment of liver function in patients with ALF in the ICU setting which is unaffected by FFP. The data suggest that the MBT may offer additional information to increase the sensitivity and specificity of the presently utilized prognostic scoring systems in patients with ALF. demonstrating the practical bed side utility of this test as a useful adjunct in the management of patients with ALF.

AB - Optimal management of patients with acute liver failure (ALF) requires timely decision making regarding transplantation (Tx). The sensitivity and specificity of presently utilized clinical, biochemical and hematological parameters vary between transplant centers and could be further improved. The use of blood products masks the coagulation tests further complicating the decision making in these patients. A bedside test that offers real time assessment of liver function may assist decision making and complement the use of standard criteria. The BreathID® continuous online 13C-methacetin breath test (MBT), enables assessment of the metabolic function of the liver at the point of care. Aim: To assess the clinical utility of the MBT in patients with ALF. Methods: Outcome was examined with regard to standard clinical criteria and MBT results. MBT was performed after an 8-hour fast and ingestion of 75 mg of Methacetin. Of the 56 patients recruited to date, 28 fulfilled the established criteria of ALF and had more than one MBT performed throughout the course of their stay in the ICU. The clinical team was blinded to the MBT data. Results: The results of ALF MBT trends in all patients were interpretable. A trend between at least two MBT tests was analyzed in all 28 eligible patients. Trends in PDR peak (percentage of 13C dose recovered/hour), and in CPDR20 (cumulative PDR at 20 minutes) were analyzed for assessment and follow up of the patients and compared with their clinical and laboratory parameters. Two sub-groups of patients were identified: a. 19 of the 28 patients received FFP, which invalidated their INR measurements. In these patients, MBT trends were unaffected by blood products, in such a way as to provide a useful adjunct tool in the decision making in patient management. In patients in who ultimately did not fulfill transplant criteria the early trend in MBT parameters showed improvement . In those who did not fulfill Tx criteria the MBT was in agreement with subsequent outcome. b. Nine of the patients did not receive blood products. The results of MBT trends in these patients were consistent with other ALF measures of severity and supportive of the clinical decisions made. Conclusions: The 13C-MBT provides a rapid, easily applied non-invasive assessment of liver function in patients with ALF in the ICU setting which is unaffected by FFP. The data suggest that the MBT may offer additional information to increase the sensitivity and specificity of the presently utilized prognostic scoring systems in patients with ALF. demonstrating the practical bed side utility of this test as a useful adjunct in the management of patients with ALF.

KW - Acute liver failure

KW - Methacetin

KW - Breath Tests

U2 - 10.1002/hep.26040

DO - 10.1002/hep.26040

M3 - Meeting abstract

SN - 0270-9139

VL - 56

SP - 970A-971A

JO - Hepatology

JF - Hepatology

M1 - 1670

T2 - 63rd Annual Meeting of the American-Association-for-the-Study-of-Liver-Diseases (AASLD)

Y2 - 9 November 2012 through 13 November 2012

ER -