Relationship of Child-Pugh classification with liver function tests and its clinical implication in patients of chronic liver disease

Child-Pugh classification currently remains the most important parameter to determine liver function in patients of chronic liver disease [CLD]. This study was carried out to find a relationship between abnormal Liver Function Tests [LFTs] and extent of liver damage in patients of CLD grouped as Child class A and B. To find a relationship between LFTs and severity of liver disease assessed by Child-Pugh scoring. Retrospective study. This study was conducted at the Medical Words of Services Hospital, Lahore from February 2009 to June 2009. It was a retrospective analysis of 40 patients aged 17-74 with CLD. Patients were selected from medical wards of Services Hospital Lahore. Patients were classified as Child class A and B on the basis of severity of liver function. Liver function tests including prothrombin time[PT], serum bilirubin, enzymes like Alkaline Phosphatase [ALP], Aspartate Transaminase [AST], Alanine Transaminase [ALT], serum Proteins and Albumin concentrations were performed by standard laboratory methods. It was observed that serum level of ALP, ALT, AST and the AST/ ALT ratio as well as prothrombin time were significantly increased in patients as compared to their controls. On the other hand level of total proteins and albumin were significantly decreased in patients as compared to their controls whereas the level of bilirubin remains insignificant. In Child class B patients the levels of serum bilirubin, ALP, ALT, AST and ratio AST/ALT were increased as compared to these parameters in Child class A patients. It was observed that level of serum ALP and ALT were non significantly and level of serum bilirubin, AST and AST/ALT ratio were significantly increased in Child class B patients as compared to the patients of Child class A. On the other hand level of serum total proteins and albumin were significantly decreased in Child class B patients as compared to patients of Child class A. Prothromin time is significantly increased in Child class B patients as compared to the patients of Child class A. Further deterioration in LFTs may warn a clinician about progress of disease in a patient of CLD and to further investigate about the liver function at that stage

Association of caffeine clearance with serum AST/ALT ratio in chronic liver disease

Background: Serum AST/ALT ratio more than one [>1] was seen to be the fIrst manifestation of cirrhosis in chronic liver disease. It was considered to be due to increased serum AST level by its release from the mitochondria of massive number of necrosed liver cells with a simultaneous decrease in serum ALT /evei due to decreased production by reduced number of living hepatocytes. It increases with increasing degree of fibrosis. Caffeine clearance test measures the hepatic microsomal function quantitatively. The aim of the present study was to find a correlation between caffeine clearance and AST/ALT ratio in patients of cirrhosis to prove the efficacy of caffeine clearance test to measure the extent of liver tibrosis

Methods: Forty [40] hospitalized patients of chronic liver disease were included in this study. According to Child Pugh scoring, twenty-seven [27] patients belonged to Child class A and thirteen [13] to Child class B. A baseline blood sample was drawn after an overnight fast immediately followed by oral administration of 200 mg caffeine. Three more blood samples were drawn after three hours intervals. Caffeine concentration was measured by High Performance Liquid Chromatography [HPLC]. 6 hours and 9 hours samples were used to measure caffeine clearance. Serum AST and ALT were measured by commercially available kits

Results: Pearson correlation test was used to establish the relationship between caffeine clearance and AST/ALT ratio. A definite negative association was found

Conclusion: Caffeine clearance test may be used to measure the functional capacity of liver in patients of liver cirrhosis