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Maciej Malinowski - One of the best experts on this subject based on the ideXlab platform.

  • Volume–Function Analysis (Limax Test) in Patients with HCC and Cirrhosis Undergoing TACE—A Feasibility Study
    Digestive Diseases and Sciences, 2020
    Co-Authors: Matthias Christian Reichert, Alexander Massmann, Antje Schulz, Arno Buecker, Matthias Glanemann, Frank Lammert, Maciej Malinowski
    Abstract:

    Background Transarterial chemoembolization (TACE) is an important therapy for hepatocellular carcinoma (HCC) in cirrhosis. In particular in advanced cirrhosis, post-TACE hepatic failure liver (PTHF) failure may develop. Currently, there is no standardization for the periinterventional risk assessment. The liver maximum capacity (Limax) test assesses the functional liver capacity, but has not been investigated in this setting. Aims The aim of this study was to prospectively evaluate periinterventional Limax and CT volumetry measurements in patients with cirrhosis and HCC undergoing repetitive TACE. Methods From 06/2016 to 11/2017, eleven patients with HCC and cirrhosis undergoing TACE were included. Limax measurements ( n  = 42) were conducted before and after each TACE. Laboratory parameters were correlated with the volume–function data. Results The median Limax levels before (276 ± 166 µg/kg/h) were slightly reduced after TACE (251 ± 122 µg/kg/h; p  = 0.08). This corresponded to a median drop of 7.1%. Notably, there was a significant correlation between Limax levels before TACE and bilirubin (but not albumin nor albumin–bilirubin [ALBI] score) increase after TACE ( p  = 0.02, k  = 0.56). Furthermore, a significantly higher increase in bilirubin in patients with Limax ≤ 150 µg/kg/h was observed ( p  = 0.011). Limax levels at different time points in single patients were similar ( p  = 0.2). Conclusion In our prospective pilot study in patients with HCC and cirrhosis undergoing multiple TACE, robust and reliable Limax measurements were demonstrated. Lower Limax levels before TACE were associated with surrogate markers (bilirubin) of liver failure after TACE. Specific subgroups at high risk of PTHF should be investigated. This might facilitate the future development of strategies to prevent occurrence of PTHF.

  • Volume-Function Analysis (Limax Test) in Patients with HCC and Cirrhosis Undergoing TACE-A Feasibility Study.
    Digestive diseases and sciences, 2020
    Co-Authors: Matthias Christian Reichert, Alexander Massmann, Antje Schulz, Arno Buecker, Matthias Glanemann, Frank Lammert, Maciej Malinowski
    Abstract:

    Background Transarterial chemoembolization (TACE) is an important therapy for hepatocellular carcinoma (HCC) in cirrhosis. In particular in advanced cirrhosis, post-TACE hepatic failure liver (PTHF) failure may develop. Currently, there is no standardization for the periinterventional risk assessment. The liver maximum capacity (Limax) test assesses the functional liver capacity, but has not been investigated in this setting. Aims The aim of this study was to prospectively evaluate periinterventional Limax and CT volumetry measurements in patients with cirrhosis and HCC undergoing repetitive TACE. Methods From 06/2016 to 11/2017, eleven patients with HCC and cirrhosis undergoing TACE were included. Limax measurements (n = 42) were conducted before and after each TACE. Laboratory parameters were correlated with the volume-function data. Results The median Limax levels before (276 ± 166 µg/kg/h) were slightly reduced after TACE (251 ± 122 µg/kg/h; p = 0.08). This corresponded to a median drop of 7.1%. Notably, there was a significant correlation between Limax levels before TACE and bilirubin (but not albumin nor albumin-bilirubin [ALBI] score) increase after TACE (p = 0.02, k = 0.56). Furthermore, a significantly higher increase in bilirubin in patients with Limax ≤ 150 µg/kg/h was observed (p = 0.011). Limax levels at different time points in single patients were similar (p = 0.2). Conclusion In our prospective pilot study in patients with HCC and cirrhosis undergoing multiple TACE, robust and reliable Limax measurements were demonstrated. Lower Limax levels before TACE were associated with surrogate markers (bilirubin) of liver failure after TACE. Specific subgroups at high risk of PTHF should be investigated. This might facilitate the future development of strategies to prevent occurrence of PTHF.

  • volume function analysis Limax test in patients with hcc and cirrhosis undergoing tace a feasibility study
    Digestive Diseases and Sciences, 2020
    Co-Authors: M Reichert, Alexander Massmann, Antje Schulz, Arno Buecker, Matthias Glanemann, Frank Lammert, Maciej Malinowski
    Abstract:

    Transarterial chemoembolization (TACE) is an important therapy for hepatocellular carcinoma (HCC) in cirrhosis. In particular in advanced cirrhosis, post-TACE hepatic failure liver (PTHF) failure may develop. Currently, there is no standardization for the periinterventional risk assessment. The liver maximum capacity (Limax) test assesses the functional liver capacity, but has not been investigated in this setting. The aim of this study was to prospectively evaluate periinterventional Limax and CT volumetry measurements in patients with cirrhosis and HCC undergoing repetitive TACE. From 06/2016 to 11/2017, eleven patients with HCC and cirrhosis undergoing TACE were included. Limax measurements (n = 42) were conducted before and after each TACE. Laboratory parameters were correlated with the volume–function data. The median Limax levels before (276 ± 166 µg/kg/h) were slightly reduced after TACE (251 ± 122 µg/kg/h; p = 0.08). This corresponded to a median drop of 7.1%. Notably, there was a significant correlation between Limax levels before TACE and bilirubin (but not albumin nor albumin–bilirubin [ALBI] score) increase after TACE (p = 0.02, k = 0.56). Furthermore, a significantly higher increase in bilirubin in patients with Limax ≤ 150 µg/kg/h was observed (p = 0.011). Limax levels at different time points in single patients were similar (p = 0.2). In our prospective pilot study in patients with HCC and cirrhosis undergoing multiple TACE, robust and reliable Limax measurements were demonstrated. Lower Limax levels before TACE were associated with surrogate markers (bilirubin) of liver failure after TACE. Specific subgroups at high risk of PTHF should be investigated. This might facilitate the future development of strategies to prevent occurrence of PTHF.

  • Kinetic validation of the Limax test during 10 000 intravenous 13C-methacetin breath tests.
    Journal of breath research, 2017
    Co-Authors: Tom Moses Rubin, Maciej Malinowski, Jan Bednarsch, Florian W R Vondran, Karsten Heyne, Axel Luchterhand, Georgios Polychronidis, Alen Nikolic, Hans-michael Tautenhahn, Maximilian Jara
    Abstract:

    The maximal liver function capacity (Limax) test, a novel 13C-methacetin breath test, has proven clinical validity in determining hepatic metabolic capacity. In contrast to prior 13C-methacetin breath test protocols, the Limax test is performed by intravenous body-weight-adjusted substrate administration. Furthermore, the DOB kinetics (delta over baseline of the time-dependent exhaled 13CO2/12CO2 ratio) are measured online at the bedside with a high time resolution in order to determine the maximum DOB. The aim of this study was to analyze the recorded DOB kinetics in a large population for further refinement of the test protocol. Two new methods of kinetic analysis are proposed in this article: the time dependency of the DOB kinetics and the time interval until half of the DOB maximum. A total of 10 100 Limax tests on 8483 patients performed during routine clinics at eight centers were available. The kinetic analysis revealed a specific pattern of DOB kinetics depending upon Limax result. In addition, potential co-factors for DOB kinetics, such as weight, height, gender and age, were analyzed, yielding a potential influence of gender and smoking behavior. Both the specific patterns and the proposed kinetic analysis have the potential to further improve the sensitivity and specificity of the test and its clinical applicability by shortening its duration.

  • Correlation between plasma endothelin-1 levels and severity of septic liver failure quantified by maximal liver function capacity (Limax test). A prospective study.
    PloS one, 2017
    Co-Authors: Magnus Kaffarnik, Navid Ahmadi, Tilo Wuensch, Johann Pratschke, Martin Stockmann, Johan F. Lock, Maciej Malinowski
    Abstract:

    Aim To investigate the relationship between the degree of liver dysfunction, quantified by maximal liver function capacity (Limax test) and endothelin-1, TNF-α and IL-6 in septic surgical patients. Methods 28 septic patients (8 female, 20 male, age range 35–80y) were prospectively investigated on a surgical intensive care unit. Liver function, defined by Limax test, and measurements of plasma levels of endothelin-1, TNF-α and IL-6 were carried out within the first 24 hours after onset of septic symptoms, followed by day 2, 5 and 10. Patients were divided into 2 groups (group A: Limax ≥100 μg/kg/h, moderate liver dysfunction; group B: Limax

Martin Stockmann - One of the best experts on this subject based on the ideXlab platform.

  • dynamic determination of functional liver capacity with the Limax test in post cardiac arrest patients undergoing targeted temperature management a prospective trial
    Acta Anaesthesiologica Scandinavica, 2020
    Co-Authors: Jens Nee, Martin Stockmann, Tim Schroeder, Florian Vornholt, Julian Schaeuble, Christoph Leithner, Christian Storm
    Abstract:

    BACKGROUND Transiently increased transaminases is a common finding after cardiac arrest but little is known about the functional liver capacity (Limax) during the post-cardiac arrest syndrome and treatment in the intensive care unit (ICU). The aim of this trial was to evaluate liver function capacity in post-cardiac arrest survivors undergoing targeted temperature management (TTM) in ICU. METHODS Thirty-two post-cardiac arrest survivors were prospectively included with all patients undergoing TTM at 33°C for 24 hours. Blood samples were collected, and Limax testing was performed at days 1, 2, 5, and 10 post-cardiac arrest. Limax is a non-invasive, in vivo, dynamic breath test determining cytochrome P450 1A2 (CYP1A2) capacity using intravenous (IV) 13 C-methacetin, thus reflecting maximum liver function capacity. Static liver parameters were determined and compared to Limax values. RESULTS A typical pattern of transiently, mildly increased transaminases was demonstrated without fulfilling the criteria for hypoxic hepatitis (HH). CYP1A2 activity was reduced with slow normalization over 10 days (lowest median 48 hours after cardiac arrest: 228.5 (25-75 percentile 105.2-301.7 μg/kg/h, P < .05). Parameters reflecting the liver synthetic function were not impaired, as assessed by, in standard laboratory testing. CONCLUSION Liver functional capacity is impaired in patients after cardiac arrest undergoing TTM at 33°C. More data are needed to determine if liver functional capacity may add relevant information, especially in the context of pharmacotherapy, to individualize post-cardiac arrest care.

  • Dynamic determination of functional liver capacity with the Limax Test in post‐cardiac arrest patients undergoing Targeted Temperature Management – a prospective trial
    Acta anaesthesiologica Scandinavica, 2019
    Co-Authors: Jens Nee, Martin Stockmann, Tim Schroeder, Florian Vornholt, Julian Schaeuble, Christoph Leithner, Christian Storm
    Abstract:

    BACKGROUND Transiently increased transaminases is a common finding after cardiac arrest but little is known about the functional liver capacity (Limax) during the post-cardiac arrest syndrome and treatment in the intensive care unit (ICU). The aim of this trial was to evaluate liver function capacity in post-cardiac arrest survivors undergoing targeted temperature management (TTM) in ICU. METHODS Thirty-two post-cardiac arrest survivors were prospectively included with all patients undergoing TTM at 33°C for 24 hours. Blood samples were collected, and Limax testing was performed at days 1, 2, 5, and 10 post-cardiac arrest. Limax is a non-invasive, in vivo, dynamic breath test determining cytochrome P450 1A2 (CYP1A2) capacity using intravenous (IV) 13 C-methacetin, thus reflecting maximum liver function capacity. Static liver parameters were determined and compared to Limax values. RESULTS A typical pattern of transiently, mildly increased transaminases was demonstrated without fulfilling the criteria for hypoxic hepatitis (HH). CYP1A2 activity was reduced with slow normalization over 10 days (lowest median 48 hours after cardiac arrest: 228.5 (25-75 percentile 105.2-301.7 μg/kg/h, P 

  • non invasive structure function assessment of the liver by 2d time harmonic elastography and the dynamic liver maximum capacity Limax test
    Journal of Gastroenterology and Hepatology, 2019
    Co-Authors: Niklas Heucke, Julia Mohr, Bruno Valentin Sinn, Magnus Kaffarnik, Tilo Wuensch, Johann Pratschke, Martin Stockmann, Ruza Arsenic, Tobias Müller, Ingolf Sack
    Abstract:

    BACKGROUND AND AIM Accurate assessment of structural and functional characteristics of the liver could improve the diagnosis and the clinical management of patients with chronic liver diseases. However, the structure-function relationship in the progression of chronic liver disease remains elusive. The aim of this study is the combined measurement of liver function by the 13 C-methacetin Liver MAximum capacity (Limax) test and tissue-structure related stiffness by 2D time-harmonic elastography for the assessment of liver disease progression. METHODS Limax test and time-harmonic elastography were applied, and the serological scores fibrosis 4 index and aspartate aminotransferase to platelet ratio index were calculated in patients with chronic liver diseases (n = 75) and healthy control subjects (n = 22). In 47 patients who underwent surgery, fibrosis was graded by histological examination of the resected liver tissue. RESULTS Limax values correlated negatively with liver stiffness (r = -0.747), aminotransferase to platelet ratio index (r = -0.604), and fibrosis 4 (r = -0.573). Median (interquartile range) Limax values decreased with fibrosis progression from 395 μg/kg/h (371-460 μg/kg/h) in participants with no fibrosis to 173 μg/kg/h (126-309 μg/kg/h) in patients with severe fibrosis. Median liver stiffness increased progressively with the stage of fibrosis from no fibrosis (1.56 m/s [1.52-1.63 m/s]) to moderate fibrosis (1.60 m/s [1.54-1.67 m/s]) to severe fibrosis (1.85 m/s [1.76-1.92 m/s]). CONCLUSION Our findings show that structural changes in the liver due to progressing liver diseases and reflected by increased tissue stiffness correlate with a functional decline of the organ as reflected by a decreased metabolic capacity of the liver.

  • Non‐invasive structure–function assessment of the liver by 2D time‐harmonic elastography and the dynamic Liver MAximum capacity (Limax) test
    Journal of gastroenterology and hepatology, 2019
    Co-Authors: Niklas Heucke, Julia Mohr, Bruno Valentin Sinn, Magnus Kaffarnik, Tilo Wuensch, Johann Pratschke, Martin Stockmann, Ruza Arsenic, Tobias Müller, Ingolf Sack
    Abstract:

    BACKGROUND AND AIM Accurate assessment of structural and functional characteristics of the liver could improve the diagnosis and the clinical management of patients with chronic liver diseases. However, the structure-function relationship in the progression of chronic liver disease remains elusive. The aim of this study is the combined measurement of liver function by the 13 C-methacetin Liver MAximum capacity (Limax) test and tissue-structure related stiffness by 2D time-harmonic elastography for the assessment of liver disease progression. METHODS Limax test and time-harmonic elastography were applied, and the serological scores fibrosis 4 index and aspartate aminotransferase to platelet ratio index were calculated in patients with chronic liver diseases (n = 75) and healthy control subjects (n = 22). In 47 patients who underwent surgery, fibrosis was graded by histological examination of the resected liver tissue. RESULTS Limax values correlated negatively with liver stiffness (r = -0.747), aminotransferase to platelet ratio index (r = -0.604), and fibrosis 4 (r = -0.573). Median (interquartile range) Limax values decreased with fibrosis progression from 395 μg/kg/h (371-460 μg/kg/h) in participants with no fibrosis to 173 μg/kg/h (126-309 μg/kg/h) in patients with severe fibrosis. Median liver stiffness increased progressively with the stage of fibrosis from no fibrosis (1.56 m/s [1.52-1.63 m/s]) to moderate fibrosis (1.60 m/s [1.54-1.67 m/s]) to severe fibrosis (1.85 m/s [1.76-1.92 m/s]). CONCLUSION Our findings show that structural changes in the liver due to progressing liver diseases and reflected by increased tissue stiffness correlate with a functional decline of the organ as reflected by a decreased metabolic capacity of the liver.

  • Non‐invasive structure–function assessment of the liver by 2D time‐harmonic elastography and the dynamic Liver MAximum capacity (Limax) test
    Journal of Gastroenterology and Hepatology, 2019
    Co-Authors: Niklas Heucke, Julia Mohr, Bruno Valentin Sinn, Magnus Kaffarnik, Tilo Wuensch, Johann Pratschke, Martin Stockmann, Ruza Arsenic, Tobias Müller, Ingolf Sack
    Abstract:

    Accurate assessment of structural and functional characteristics of the liver could improve the diagnosis and the clinical management of patients with chronic liver diseases. However, the structure-function relationship in the progression of chronic liver disease remains elusive. The aim of this study is the combined measurement of liver function by the 13 C-methacetin Liver MAximum capacity (Limax) test and tissue-structure related stiffness by 2D time-harmonic elastography for the assessment of liver disease progression. Limax test and time-harmonic elastography were applied, and the serological scores fibrosis 4 index and aspartate aminotransferase to platelet ratio index were calculated in patients with chronic liver diseases (n = 75) and healthy control subjects (n = 22). In 47 patients who underwent surgery, fibrosis was graded by histological examination of the resected liver tissue. Limax values correlated negatively with liver stiffness (r = -0.747), aminotransferase to platelet ratio index (r = -0.604), and fibrosis 4 (r = -0.573). Median (interquartile range) Limax values decreased with fibrosis progression from 395 μg/kg/h (371-460 μg/kg/h) in participants with no fibrosis to 173 μg/kg/h (126-309 μg/kg/h) in patients with severe fibrosis. Median liver stiffness increased progressively with the stage of fibrosis from no fibrosis (1.56 m/s [1.52-1.63 m/s]) to moderate fibrosis (1.60 m/s [1.54-1.67 m/s]) to severe fibrosis (1.85 m/s [1.76-1.92 m/s]). Our findings show that structural changes in the liver due to progressing liver diseases and reflected by increased tissue stiffness correlate with a functional decline of the organ as reflected by a decreased metabolic capacity of the liver. © 2019 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

Philipp Bruners - One of the best experts on this subject based on the ideXlab platform.

  • Monitoring Liver Function of Patients Undergoing Transarterial Chemoembolization (TACE) by a 13C Breath Test (Limax).
    Cardiovascular and interventional radiology, 2019
    Co-Authors: Emona S. Barzakova, Maximilian Schulze-hagen, Markus Zimmermann, Georg Lurje, Jan Bednarsch, F Pedersoli, Peter Isfort, Christiane K. Kuhl, Philipp Bruners
    Abstract:

    Transarterial chemoembolization (TACE) is associated with the risk of deteriorating liver function, especially in patients with preexisting liver damage. Current liver function tests may fail to accurately predict the functional liver reserve. Aim of this study was to investigate whether changes of liver function caused by TACE are associated with detectable changes of Limax values. Forty patients with primary or secondary liver cancer underwent TACE and Limax test on the day before, the day after, and 4 weeks after TACE. Limax results were evaluated, referenced to liver volume (CT/MR volumetry), correlated with the respective TACE volume (subsegmental vs. segmental vs. lobar), established liver function tests, and Child–Pugh and ALBI scores. The individual Limax values were significantly reduced by 10% (p = 0.01) on the day after TACE and fully recovered to baseline 1 month after treatment. Similar changes were observed regarding levels of bilirubin, transaminases, albumin, INR, and creatinine. Limax did not correlate significantly with the treated liver volume, but did correlate with the baseline liver volume (  1200 ml; p 

  • monitoring liver function of patients undergoing transarterial chemoembolization tace by a 13c breath test Limax
    CardioVascular and Interventional Radiology, 2019
    Co-Authors: Emona S. Barzakova, Markus Zimmermann, Georg Lurje, Jan Bednarsch, F Pedersoli, Peter Isfort, Christiane K. Kuhl, Maximilian Schulzehagen, Philipp Bruners
    Abstract:

    Transarterial chemoembolization (TACE) is associated with the risk of deteriorating liver function, especially in patients with preexisting liver damage. Current liver function tests may fail to accurately predict the functional liver reserve. Aim of this study was to investigate whether changes of liver function caused by TACE are associated with detectable changes of Limax values. Forty patients with primary or secondary liver cancer underwent TACE and Limax test on the day before, the day after, and 4 weeks after TACE. Limax results were evaluated, referenced to liver volume (CT/MR volumetry), correlated with the respective TACE volume (subsegmental vs. segmental vs. lobar), established liver function tests, and Child–Pugh and ALBI scores. The individual Limax values were significantly reduced by 10% (p = 0.01) on the day after TACE and fully recovered to baseline 1 month after treatment. Similar changes were observed regarding levels of bilirubin, transaminases, albumin, INR, and creatinine. Limax did not correlate significantly with the treated liver volume, but did correlate with the baseline liver volume (  1200 ml; p < 0.01). No significant changes were observed in the Child–Pugh score or ALBI score. Limax is capable of detecting changes in liver function, even modulations caused by superselective TACE procedures. Accordingly, it could be used as a tool for patient selection and monitoring of transarterial therapy. In comparison, Child–Pugh and ALBI scores did not reflect any of these changes. Some biochemical parameters also changed significantly after TACE, but they tend to be less specific in providing sufficient information on actual cellular dysfunction.

Ingolf Sack - One of the best experts on this subject based on the ideXlab platform.

  • Non‐invasive structure–function assessment of the liver by 2D time‐harmonic elastography and the dynamic Liver MAximum capacity (Limax) test
    Journal of Gastroenterology and Hepatology, 2019
    Co-Authors: Niklas Heucke, Julia Mohr, Bruno Valentin Sinn, Magnus Kaffarnik, Tilo Wuensch, Johann Pratschke, Martin Stockmann, Ruza Arsenic, Tobias Müller, Ingolf Sack
    Abstract:

    Accurate assessment of structural and functional characteristics of the liver could improve the diagnosis and the clinical management of patients with chronic liver diseases. However, the structure-function relationship in the progression of chronic liver disease remains elusive. The aim of this study is the combined measurement of liver function by the 13 C-methacetin Liver MAximum capacity (Limax) test and tissue-structure related stiffness by 2D time-harmonic elastography for the assessment of liver disease progression. Limax test and time-harmonic elastography were applied, and the serological scores fibrosis 4 index and aspartate aminotransferase to platelet ratio index were calculated in patients with chronic liver diseases (n = 75) and healthy control subjects (n = 22). In 47 patients who underwent surgery, fibrosis was graded by histological examination of the resected liver tissue. Limax values correlated negatively with liver stiffness (r = -0.747), aminotransferase to platelet ratio index (r = -0.604), and fibrosis 4 (r = -0.573). Median (interquartile range) Limax values decreased with fibrosis progression from 395 μg/kg/h (371-460 μg/kg/h) in participants with no fibrosis to 173 μg/kg/h (126-309 μg/kg/h) in patients with severe fibrosis. Median liver stiffness increased progressively with the stage of fibrosis from no fibrosis (1.56 m/s [1.52-1.63 m/s]) to moderate fibrosis (1.60 m/s [1.54-1.67 m/s]) to severe fibrosis (1.85 m/s [1.76-1.92 m/s]). Our findings show that structural changes in the liver due to progressing liver diseases and reflected by increased tissue stiffness correlate with a functional decline of the organ as reflected by a decreased metabolic capacity of the liver. © 2019 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

  • Non‐invasive structure–function assessment of the liver by 2D time‐harmonic elastography and the dynamic Liver MAximum capacity (Limax) test
    Journal of gastroenterology and hepatology, 2019
    Co-Authors: Niklas Heucke, Julia Mohr, Bruno Valentin Sinn, Magnus Kaffarnik, Tilo Wuensch, Johann Pratschke, Martin Stockmann, Ruza Arsenic, Tobias Müller, Ingolf Sack
    Abstract:

    BACKGROUND AND AIM Accurate assessment of structural and functional characteristics of the liver could improve the diagnosis and the clinical management of patients with chronic liver diseases. However, the structure-function relationship in the progression of chronic liver disease remains elusive. The aim of this study is the combined measurement of liver function by the 13 C-methacetin Liver MAximum capacity (Limax) test and tissue-structure related stiffness by 2D time-harmonic elastography for the assessment of liver disease progression. METHODS Limax test and time-harmonic elastography were applied, and the serological scores fibrosis 4 index and aspartate aminotransferase to platelet ratio index were calculated in patients with chronic liver diseases (n = 75) and healthy control subjects (n = 22). In 47 patients who underwent surgery, fibrosis was graded by histological examination of the resected liver tissue. RESULTS Limax values correlated negatively with liver stiffness (r = -0.747), aminotransferase to platelet ratio index (r = -0.604), and fibrosis 4 (r = -0.573). Median (interquartile range) Limax values decreased with fibrosis progression from 395 μg/kg/h (371-460 μg/kg/h) in participants with no fibrosis to 173 μg/kg/h (126-309 μg/kg/h) in patients with severe fibrosis. Median liver stiffness increased progressively with the stage of fibrosis from no fibrosis (1.56 m/s [1.52-1.63 m/s]) to moderate fibrosis (1.60 m/s [1.54-1.67 m/s]) to severe fibrosis (1.85 m/s [1.76-1.92 m/s]). CONCLUSION Our findings show that structural changes in the liver due to progressing liver diseases and reflected by increased tissue stiffness correlate with a functional decline of the organ as reflected by a decreased metabolic capacity of the liver.

  • non invasive structure function assessment of the liver by 2d time harmonic elastography and the dynamic liver maximum capacity Limax test
    Journal of Gastroenterology and Hepatology, 2019
    Co-Authors: Niklas Heucke, Julia Mohr, Bruno Valentin Sinn, Magnus Kaffarnik, Tilo Wuensch, Johann Pratschke, Martin Stockmann, Ruza Arsenic, Tobias Müller, Ingolf Sack
    Abstract:

    BACKGROUND AND AIM Accurate assessment of structural and functional characteristics of the liver could improve the diagnosis and the clinical management of patients with chronic liver diseases. However, the structure-function relationship in the progression of chronic liver disease remains elusive. The aim of this study is the combined measurement of liver function by the 13 C-methacetin Liver MAximum capacity (Limax) test and tissue-structure related stiffness by 2D time-harmonic elastography for the assessment of liver disease progression. METHODS Limax test and time-harmonic elastography were applied, and the serological scores fibrosis 4 index and aspartate aminotransferase to platelet ratio index were calculated in patients with chronic liver diseases (n = 75) and healthy control subjects (n = 22). In 47 patients who underwent surgery, fibrosis was graded by histological examination of the resected liver tissue. RESULTS Limax values correlated negatively with liver stiffness (r = -0.747), aminotransferase to platelet ratio index (r = -0.604), and fibrosis 4 (r = -0.573). Median (interquartile range) Limax values decreased with fibrosis progression from 395 μg/kg/h (371-460 μg/kg/h) in participants with no fibrosis to 173 μg/kg/h (126-309 μg/kg/h) in patients with severe fibrosis. Median liver stiffness increased progressively with the stage of fibrosis from no fibrosis (1.56 m/s [1.52-1.63 m/s]) to moderate fibrosis (1.60 m/s [1.54-1.67 m/s]) to severe fibrosis (1.85 m/s [1.76-1.92 m/s]). CONCLUSION Our findings show that structural changes in the liver due to progressing liver diseases and reflected by increased tissue stiffness correlate with a functional decline of the organ as reflected by a decreased metabolic capacity of the liver.

Johann Pratschke - One of the best experts on this subject based on the ideXlab platform.

  • Non‐invasive structure–function assessment of the liver by 2D time‐harmonic elastography and the dynamic Liver MAximum capacity (Limax) test
    Journal of gastroenterology and hepatology, 2019
    Co-Authors: Niklas Heucke, Julia Mohr, Bruno Valentin Sinn, Magnus Kaffarnik, Tilo Wuensch, Johann Pratschke, Martin Stockmann, Ruza Arsenic, Tobias Müller, Ingolf Sack
    Abstract:

    BACKGROUND AND AIM Accurate assessment of structural and functional characteristics of the liver could improve the diagnosis and the clinical management of patients with chronic liver diseases. However, the structure-function relationship in the progression of chronic liver disease remains elusive. The aim of this study is the combined measurement of liver function by the 13 C-methacetin Liver MAximum capacity (Limax) test and tissue-structure related stiffness by 2D time-harmonic elastography for the assessment of liver disease progression. METHODS Limax test and time-harmonic elastography were applied, and the serological scores fibrosis 4 index and aspartate aminotransferase to platelet ratio index were calculated in patients with chronic liver diseases (n = 75) and healthy control subjects (n = 22). In 47 patients who underwent surgery, fibrosis was graded by histological examination of the resected liver tissue. RESULTS Limax values correlated negatively with liver stiffness (r = -0.747), aminotransferase to platelet ratio index (r = -0.604), and fibrosis 4 (r = -0.573). Median (interquartile range) Limax values decreased with fibrosis progression from 395 μg/kg/h (371-460 μg/kg/h) in participants with no fibrosis to 173 μg/kg/h (126-309 μg/kg/h) in patients with severe fibrosis. Median liver stiffness increased progressively with the stage of fibrosis from no fibrosis (1.56 m/s [1.52-1.63 m/s]) to moderate fibrosis (1.60 m/s [1.54-1.67 m/s]) to severe fibrosis (1.85 m/s [1.76-1.92 m/s]). CONCLUSION Our findings show that structural changes in the liver due to progressing liver diseases and reflected by increased tissue stiffness correlate with a functional decline of the organ as reflected by a decreased metabolic capacity of the liver.

  • Non‐invasive structure–function assessment of the liver by 2D time‐harmonic elastography and the dynamic Liver MAximum capacity (Limax) test
    Journal of Gastroenterology and Hepatology, 2019
    Co-Authors: Niklas Heucke, Julia Mohr, Bruno Valentin Sinn, Magnus Kaffarnik, Tilo Wuensch, Johann Pratschke, Martin Stockmann, Ruza Arsenic, Tobias Müller, Ingolf Sack
    Abstract:

    Accurate assessment of structural and functional characteristics of the liver could improve the diagnosis and the clinical management of patients with chronic liver diseases. However, the structure-function relationship in the progression of chronic liver disease remains elusive. The aim of this study is the combined measurement of liver function by the 13 C-methacetin Liver MAximum capacity (Limax) test and tissue-structure related stiffness by 2D time-harmonic elastography for the assessment of liver disease progression. Limax test and time-harmonic elastography were applied, and the serological scores fibrosis 4 index and aspartate aminotransferase to platelet ratio index were calculated in patients with chronic liver diseases (n = 75) and healthy control subjects (n = 22). In 47 patients who underwent surgery, fibrosis was graded by histological examination of the resected liver tissue. Limax values correlated negatively with liver stiffness (r = -0.747), aminotransferase to platelet ratio index (r = -0.604), and fibrosis 4 (r = -0.573). Median (interquartile range) Limax values decreased with fibrosis progression from 395 μg/kg/h (371-460 μg/kg/h) in participants with no fibrosis to 173 μg/kg/h (126-309 μg/kg/h) in patients with severe fibrosis. Median liver stiffness increased progressively with the stage of fibrosis from no fibrosis (1.56 m/s [1.52-1.63 m/s]) to moderate fibrosis (1.60 m/s [1.54-1.67 m/s]) to severe fibrosis (1.85 m/s [1.76-1.92 m/s]). Our findings show that structural changes in the liver due to progressing liver diseases and reflected by increased tissue stiffness correlate with a functional decline of the organ as reflected by a decreased metabolic capacity of the liver. © 2019 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

  • non invasive structure function assessment of the liver by 2d time harmonic elastography and the dynamic liver maximum capacity Limax test
    Journal of Gastroenterology and Hepatology, 2019
    Co-Authors: Niklas Heucke, Julia Mohr, Bruno Valentin Sinn, Magnus Kaffarnik, Tilo Wuensch, Johann Pratschke, Martin Stockmann, Ruza Arsenic, Tobias Müller, Ingolf Sack
    Abstract:

    BACKGROUND AND AIM Accurate assessment of structural and functional characteristics of the liver could improve the diagnosis and the clinical management of patients with chronic liver diseases. However, the structure-function relationship in the progression of chronic liver disease remains elusive. The aim of this study is the combined measurement of liver function by the 13 C-methacetin Liver MAximum capacity (Limax) test and tissue-structure related stiffness by 2D time-harmonic elastography for the assessment of liver disease progression. METHODS Limax test and time-harmonic elastography were applied, and the serological scores fibrosis 4 index and aspartate aminotransferase to platelet ratio index were calculated in patients with chronic liver diseases (n = 75) and healthy control subjects (n = 22). In 47 patients who underwent surgery, fibrosis was graded by histological examination of the resected liver tissue. RESULTS Limax values correlated negatively with liver stiffness (r = -0.747), aminotransferase to platelet ratio index (r = -0.604), and fibrosis 4 (r = -0.573). Median (interquartile range) Limax values decreased with fibrosis progression from 395 μg/kg/h (371-460 μg/kg/h) in participants with no fibrosis to 173 μg/kg/h (126-309 μg/kg/h) in patients with severe fibrosis. Median liver stiffness increased progressively with the stage of fibrosis from no fibrosis (1.56 m/s [1.52-1.63 m/s]) to moderate fibrosis (1.60 m/s [1.54-1.67 m/s]) to severe fibrosis (1.85 m/s [1.76-1.92 m/s]). CONCLUSION Our findings show that structural changes in the liver due to progressing liver diseases and reflected by increased tissue stiffness correlate with a functional decline of the organ as reflected by a decreased metabolic capacity of the liver.

  • Linezolid in liver failure: exploring the value of the maximal liver function capacity (Limax) test in a pharmacokinetic pilot study
    International journal of antimicrobial agents, 2017
    Co-Authors: Sebastian G. Wicha, Tilo Wuensch, Johann Pratschke, Martin Stockmann, Otto R. Frey, Anka C. Roehr, Rawan Alraish, Magnus Kaffarnik
    Abstract:

    Abstract Patients in the intensive care unit frequently require antibiotic treatment. Liver impairment poses substantial challenges for dose selection in these patients. The aim of the present pilot study was to assess the novel maximal liver function capacity (Limax test) in comparison with conventional liver function markers as covariates of drug clearance in liver failure using linezolid as a model drug. A total of 28 patients with different degrees of liver failure were recruited. Limax test as well as plasma, dialysate and urine sampling were performed under linezolid steady-state therapy (600 mg twice daily). NONMEM® was used for a pharmacometric analysis in which the different clearance routes of linezolid were elucidated. Linezolid pharmacokinetics was highly variable in patients with liver failure. The Limax score displayed the strongest association with non-renal clearance (CLnon-renal) [ = 4.46∙(body weight/57.9) 0.75∙(Limax/221.5)0.388 L/h], which reduced interindividual variability in CLnon-renal from 46.6% to 33.6%, thereby being superior to other common markers of liver function (international normalised ratio, gamma-glutaryl transferase, bilirubin, thrombocytes, alanine aminotransferase, aspartate aminotransferase). For Limax

  • correlation between plasma endothelin 1 levels and severity of septic liver failure quantified by maximal liver function capacity Limax test a prospective study
    PLOS ONE, 2017
    Co-Authors: Magnus Kaffarnik, Navid Ahmadi, J F Lock, Tilo Wuensch, Johann Pratschke, Martin Stockmann, M. Malinowski
    Abstract:

    Aim To investigate the relationship between the degree of liver dysfunction, quantified by maximal liver function capacity (Limax test) and endothelin-1, TNF-α and IL-6 in septic surgical patients. Methods 28 septic patients (8 female, 20 male, age range 35–80y) were prospectively investigated on a surgical intensive care unit. Liver function, defined by Limax test, and measurements of plasma levels of endothelin-1, TNF-α and IL-6 were carried out within the first 24 hours after onset of septic symptoms, followed by day 2, 5 and 10. Patients were divided into 2 groups (group A: Limax ≥100 μg/kg/h, moderate liver dysfunction; group B: Limax <100 μg/kg/h, severe liver dysfunction) for analysis and investigated regarding the correlation between endothelin-1 and the severity of liver failure, quantified by Limax test. Results Group B showed significant higher results for endothelin-1 than patients in group A (P = 0.01, d5; 0.02, d10). For TNF-α, group B revealed higher results than group A, with a significant difference on day 10 (P = 0.005). IL-6 showed a non-significant trend to higher results in group B. The Spearman's rank correlation coefficient revealed a significant correlation between Limax and endothelin-1 (-0.434; P <0.001), TNF-α (-0.515; P <0.001) and IL-6 (-0.590; P <0.001). Conclusions Sepsis-related hepatic dysfunction is associated with elevated plasma levels of endothelin-1, TNF-α and IL-6. Low Limax results combined with increased endothelin-1 and TNF-α and a favourable correlation between Limax and cytokine values support the findings of a crucial role of Endothelin-1 and TNF-α in development of septic liver failure.