Point-of-care continuous (13)C-methacetin breath test improves decision making in acute liver disease: results of a pilot clinical trial

Abstract

Aim: To assess the role of the (13)C-methacetin breath test (MBT) in patients with acute liver disease.

Methods: Fifteen patients with severe acute liver disease from diverse etiologies were followed-up with (13)C-MBT during the acute phase of their illnesses (range 3-116 d after treatment). Patients fasted for 8 h and ingested 75 mg of methacetin prior to the MBT. We compared results from standard clinical assessment, serum liver enzymes, synthetic function, and breath test scores.

Results: Thirteen patients recovered and two patients died. In patients that recovered, MBT parameters improved in parallel with improvements in lab results. Evidence of consistent improvement began on day 3 for MBT parameters and between days 7 and 9 for blood tests. Later convergence to normality occurred at an average of 9 d for MBT parameters and from 13 to 28 d for blood tests. In both patients that died, MBT parameters remained low despite fluctuating laboratory values.

Conclusion: The (13)C-MBT provides a rapid, non-invasive assessment of liver function in acute severe liver disease of diverse etiologies. The results of this pilot clinical trial suggest that the MBT may offer greater sensitivity than standard clinical tests for managing patients with severe acute liver disease.

Figure 1

This is an illustration of typical breath test and blood test results plotted over the clinical time course. The wide green line indicates the range of normal values. As the patient recovered, test results converged toward normality.

Figure 2

The clinical course of a patient with fulminant auto-immune hepatitis. A: Upon admission, aminotransferase levels were well above 10 × ULN, INR was increased, and breath test values were low. The patient received treatment with steroids and recovered rapidly. The breath test values normalized within 3 d, but blood tests began normalizing 2 d later; B: Despite therapy with steroids, this patient failed to improve, developed gram negative sepsis, and died. Note that despite stable blood tests, there was a lack of improvement in breath test values. The low breath test values may have been a negative prognostic factor in this patient and may have provided a rationale for early transplantation.