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. 1992 Jun;33(6):836–842. doi: 10.1136/gut.33.6.836

Aminopyrine breath test in the prognostic evaluation of patients with cirrhosis.

C Merkel 1, M Bolognesi 1, S Bellon 1, S Bianco 1, B Honisch 1, H Lampe 1, P Angeli 1, A Gatta 1
PMCID: PMC1379346  PMID: 1624169

Abstract

This prospective study assessed the role of aminopyrine breath test in the prognosis of patients with cirrhosis, and evaluated whether the test provided useful information not included in the Pugh score. During a period of 36 months, 125 patients with biopsy proven liver cirrhosis were included, and followed for up to 48 months (median 17 months). During follow up 43 patients died (20 of liver failure). Survival was univariately related to aminopyrine breath test (p less than 0.02), Pugh score (p less than 0.01), presence of ascites (p less than 0.01), and sex (p less than 0.05). Using Cox's regression analysis, Pugh score, aminopyrine breath test, and sex, were independent significant predictors of survival. From the Cox's model a prognostic index was computed. According to a receiver operating characteristic curve analysis, the prognostic index predicting death showed an improvement in area under the curve when compared with a prognostic index calculated excluding aminopyrine breath test, but the improvement did not reach statistical significance (p = 0.12). A similar prognostic index was calculated to predict death from liver failure. Cox's regression analysis selected aminopyrine breath test, Pugh score, and aetiology as the best set of predictor covariates. According to a receiver operating characteristic curve analysis, a prognostic index cut off value of 2.6 had a 94% sensitivity and a 88% specificity. The prognostic index significantly improved prognostic accuracy when compared with a prognostic index calculated from Pugh score and aetiology, but excluding aminopyrine breath test (p = 0.05). These data disclose that the aminopyrine breath test offers additional prognostic information to the Pugh score, and the prognosis of patients with cirrhosis.

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Selected References

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  1. Adler M., Van Laethem J., Glibert A., Gelin M., Bourgeois N., Vereerstraeten P., Cremer M. Factors influencing survival at one year in patients with nonbiliary hepatic parenchymal cirrhosis. Dig Dis Sci. 1990 Jan;35(1):1–5. doi: 10.1007/BF01537214. [DOI] [PubMed] [Google Scholar]
  2. Bircher J. Quantitative assessment of deranged hepatic function: a missed opportunity? Semin Liver Dis. 1983 Nov;3(4):275–284. doi: 10.1055/s-2008-1040780. [DOI] [PubMed] [Google Scholar]
  3. Branch R. A. Drugs as indicators of hepatic function. Hepatology. 1982 Jan-Feb;2(1):97–105. doi: 10.1002/hep.1840020115. [DOI] [PubMed] [Google Scholar]
  4. Christensen E., Schlichting P., Fauerholdt L., Gluud C., Andersen P. K., Juhl E., Poulsen H., Tygstrup N. Prognostic value of Child-Turcotte criteria in medically treated cirrhosis. Hepatology. 1984 May-Jun;4(3):430–435. doi: 10.1002/hep.1840040313. [DOI] [PubMed] [Google Scholar]
  5. Conn H. O. A peek at the Child-Turcotte classification. Hepatology. 1981 Nov-Dec;1(6):673–676. doi: 10.1002/hep.1840010617. [DOI] [PubMed] [Google Scholar]
  6. Gill R. A., Goodman M. W., Golfus G. R., Onstad G. R., Bubrick M. P. Aminopyrine breath test predicts surgical risk for patients with liver disease. Ann Surg. 1983 Dec;198(6):701–704. doi: 10.1097/00000658-198312000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Hanley J. A., McNeil B. J. A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology. 1983 Sep;148(3):839–843. doi: 10.1148/radiology.148.3.6878708. [DOI] [PubMed] [Google Scholar]
  8. Hanley J. A., McNeil B. J. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology. 1982 Apr;143(1):29–36. doi: 10.1148/radiology.143.1.7063747. [DOI] [PubMed] [Google Scholar]
  9. Henry D. A., Kitchingman G., Langman M. J. [14C]Aminopyrine breath analysis and conventional biochemical tests as predictors of survival in cirrhosis. Dig Dis Sci. 1985 Sep;30(9):813–818. doi: 10.1007/BF01309509. [DOI] [PubMed] [Google Scholar]
  10. Hepner G. W., Vesell E. S. Quantitative assessment of hepatic function by breath analysis after oral administration of (14C)aminopyrine. Ann Intern Med. 1975 Nov;83(5):632–638. doi: 10.7326/0003-4819-83-5-632. [DOI] [PubMed] [Google Scholar]
  11. Hofmann A. F. The aminopyrine demethylation breath test and the serum bile acid level: nominated but not yet elected to join the common liver tests. Hepatology. 1982 Jul-Aug;2(4):512–517. doi: 10.1002/hep.1840020420. [DOI] [PubMed] [Google Scholar]
  12. Infante-Rivard C., Esnaola S., Villeneuve J. P. Clinical and statistical validity of conventional prognostic factors in predicting short-term survival among cirrhotics. Hepatology. 1987 Jul-Aug;7(4):660–664. doi: 10.1002/hep.1840070408. [DOI] [PubMed] [Google Scholar]
  13. MANTEL N., HAENSZEL W. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst. 1959 Apr;22(4):719–748. [PubMed] [Google Scholar]
  14. Merkel C., Bolognesi M., Finucci G. F., Angeli P., Caregaro L., Rondana M., Gatta A. Indocyanine green intrinsic hepatic clearance as a prognostic index of survival in patients with cirrhosis. J Hepatol. 1989 Jul;9(1):16–22. doi: 10.1016/0168-8278(89)90070-6. [DOI] [PubMed] [Google Scholar]
  15. Merkel C., Sacerdoti D., Finucci G. F., Zuin R., Bazzerla G., Bolognesi M., Gatta A. Effect of nadolol on liver haemodynamics and function in patients with cirrhosis. Br J Clin Pharmacol. 1986 Jun;21(6):713–719. doi: 10.1111/j.1365-2125.1986.tb05237.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Orrego H., Israel Y., Blake J. E., Medline A. Assessment of prognostic factors in alcoholic liver disease: toward a global quantitative expression of severity. Hepatology. 1983 Nov-Dec;3(6):896–905. doi: 10.1002/hep.1840030602. [DOI] [PubMed] [Google Scholar]
  17. Peto R., Pike M. C., Armitage P., Breslow N. E., Cox D. R., Howard S. V., Mantel N., McPherson K., Peto J., Smith P. G. Design and analysis of randomized clinical trials requiring prolonged observation of each patient. II. analysis and examples. Br J Cancer. 1977 Jan;35(1):1–39. doi: 10.1038/bjc.1977.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Pignon J. P., Poynard T., Naveau S., Marteau P., Zourabichvili O., Chaput J. C. Analyse multidimensionnelle selon le modèle de Cox de la survie de patients atteints de cirrhose alcoolique. Gastroenterol Clin Biol. 1986 Jun-Jul;10(6-7):461–467. [PubMed] [Google Scholar]
  19. Pugh R. N., Murray-Lyon I. M., Dawson J. L., Pietroni M. C., Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973 Aug;60(8):646–649. doi: 10.1002/bjs.1800600817. [DOI] [PubMed] [Google Scholar]
  20. Rossi L., Milani A., Marra L., Siciliano M. Grading scores and survivorship functions in liver cirrhosis: a comparative statistical analysis of various predictive models. Hepatogastroenterology. 1986 Dec;33(6):240–243. [PubMed] [Google Scholar]
  21. Saunders J. B., Wright N., Lewis K. O. Predicting outcome of paracetamol poisoning by use 14C-aminopyrine breath test. Br Med J. 1980 Feb 2;280(6210):279–280. doi: 10.1136/bmj.280.6210.279. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Schlichting P., Christensen E., Andersen P. K., Fauerholdt L., Juhl E., Poulsen H., Tygstrup N. Prognostic factors in cirrhosis identified by Cox's regression model. Hepatology. 1983 Nov-Dec;3(6):889–895. doi: 10.1002/hep.1840030601. [DOI] [PubMed] [Google Scholar]
  23. Schneider J. F., Baker A. L., Haines N. W., Hatfield G., Boyer J. L. Aminopyrine N-demethylation: a prognostic test of liver function in patients with alcoholic liver disease. Gastroenterology. 1980 Dec;79(6):1145–1150. [PubMed] [Google Scholar]
  24. Villeneuve J. P., Infante-Rivard C., Ampelas M., Pomier-Layrargues G., Huet P. M., Marleau D. Prognostic value of the aminopyrine breath test in cirrhotic patients. Hepatology. 1986 Sep-Oct;6(5):928–931. doi: 10.1002/hep.1840060520. [DOI] [PubMed] [Google Scholar]

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