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Florian Ulmer - One of the best experts on this subject based on the ideXlab platform.
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Noninvasive Evaluation of Liver Function in Morbidly Obese Patients
Gastroenterology research and practice, 2019Co-Authors: Patrick H. Alizai, Isabella Lurje, Andreas Kroh, Sophia Schmitz, Tom Luedde, Julia Andruszkow, Ulf P. Neumann, Florian UlmerAbstract:Background. More than half of the obese patients develop nonalcoholic fatty Liver disease (NAFLD), which may further progress to nonalcoholic steatohepatitis (NASH) and cirrhosis. The aim of this study was to assess alterations in Liver Function in obese patients with a noninvasive Liver Function test. Methods. In a prospective cohort study 102 morbidly obese patients undergoing bariatric surgery were evaluated for their Liver Function. Liver Function capacity was determined by the LiMAx® test (enzymatic capacity of cytochrome P450 1A2). Liver biopsy specimens were obtained intraoperatively and classified according to the NAFLD Activity Score (NAS). NASH clinical score was additionally calculated from laboratory and clinical parameters. Results. Median Liver Function capacity was 286 ( ) μg/kg/h. 27% of patients were histologically categorized as definite NASH, 39% as borderline, and 34% as not NASH. A significant correlation was observed between Liver Function capacity and NAS ( ; ). The sensitivity and specificity of the LiMAx® test to distinguish between definite NASH and not NASH were 85.2% and 82.9% (AUROC 0.859), respectively. According to the NASH clinical scoring system, 14% were classified as low risk, 31% as intermediate, 26% as high, and 29% as very high risk. Liver Function capacity is also significantly correlated with the NASH clinical scoring system ( ; ). Conclusions. Obese patients show a diminished Liver Function capacity, especially those suffering from type 2 diabetes. The Liver Function capacity correlates with histological and clinical scoring systems. The LiMAx® test may be a valuable tool for noninvasive screening for NASH in obese patients.
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Noninvasive Evaluation of Liver Function in Morbidly Obese Patients
Hindawi Limited, 2019Co-Authors: Patrick H. Alizai, Isabella Lurje, Andreas Kroh, Sophia Schmitz, Tom Luedde, Julia Andruszkow, Ulf P. Neumann, Florian UlmerAbstract:Background. More than half of the obese patients develop nonalcoholic fatty Liver disease (NAFLD), which may further progress to nonalcoholic steatohepatitis (NASH) and cirrhosis. The aim of this study was to assess alterations in Liver Function in obese patients with a noninvasive Liver Function test. Methods. In a prospective cohort study 102 morbidly obese patients undergoing bariatric surgery were evaluated for their Liver Function. Liver Function capacity was determined by the LiMAx® test (enzymatic capacity of cytochrome P450 1A2). Liver biopsy specimens were obtained intraoperatively and classified according to the NAFLD Activity Score (NAS). NASH clinical score was additionally calculated from laboratory and clinical parameters. Results. Median Liver Function capacity was 286 (IQR=141) μg/kg/h. 27% of patients were histologically categorized as definite NASH, 39% as borderline, and 34% as not NASH. A significant correlation was observed between Liver Function capacity and NAS (r=−0.492; p
Thomas M. Van Gulik - One of the best experts on this subject based on the ideXlab platform.
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Current Modalities for the Assessment of Future Remnant Liver Function.
Visceral medicine, 2017Co-Authors: Fadi Rassam, Roelof J. Bennink, Pim B. Olthof, Thomas M. Van GulikAbstract:While imaging studies such as computed tomography or magnetic resonance imaging allow the volumetric assessment of the Liver segments, only indirect information is provided concerning the quality of the Liver parenchyma and its actual Functional capacity. Assessment of Liver Function is therefore crucial in the preoperative workup of patients who require extensive Liver resection and in whom portal vein embolization is considered. This review deals with the modalities currently available for the measurement of Liver Function. Passive Liver Function tests include biochemical parameters and clinical grading systems such as the Child-Pugh and MELD scores. Dynamic quantitative tests of Liver Function can be based on clearance capacity tests such as the indocyanine green (ICG) clearance test. Although widely used, discrepancies have been reported for the ICG clearance test in relation with clinical outcome. Nuclear imaging studies have the advantage of providing simultaneous morphologic (visual) and physiologic (quantitative Functional) information about the Liver. In addition, regional (segmental) differentiation allows specific Functional assessment of the future remnant Liver. Technetium-99m (99mTc)-galactosyl human serum albumin scintigraphy and 99mTc-mebrofenin hepatobiliary scintigraphy potentially identify patients at risk for post-resectional Liver failure who might benefit from Liver-augmenting techniques. As there is no one test that can measure all the components of Liver Function, Liver Functional reserve is estimated based on a combination of clinical parameters and quantitative Liver Function tests.
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Liver Function declines with increased age.
HPB : the official journal of the International Hepato Pancreato Biliary Association, 2016Co-Authors: Kasia P. Cieslak, Onno Baur, Joanne Verheij, Roelof J. Bennink, Thomas M. Van GulikAbstract:Introduction Age itself is not considered a contraindication for high impact surgery. However, the aging process of the Liver remains largely unknown. This study evaluates age-dependent changes in Liver Function using a quantitative Liver Function test.
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Monitoring of Total and Regional Liver Function after SIRT.
Frontiers in oncology, 2014Co-Authors: Roelof J. Bennink, Kasia P. Cieslak, Otto M. Van Delden, Krijn P. Van Lienden, Heinz-josef Klümpen, Peter L. M. Jansen, Thomas M. Van GulikAbstract:Selective internal radiation therapy (SIRT) is a promising treatment modality for advanced hepatocellular carcinoma or metastatic Liver cancer. SIRT is usually well tolerated. However, in most patients, SIRT will result in a (temporary) decreased Liver Function. Occasionally patients develop radioembolization induced Liver disease (REILD). In case of a high tumor burden of the Liver it could be beneficial to perform SIRT in two sessions enabling the primary untreated Liver segments to guarantee Liver Function until Function in the treated segments has recovered, or Functional hypertrophy has occurred. Clinically used Liver Function tests provide evidence of only one of the many Liver Functions, though all of them lack the possibility of assessment of segmental (regional) Liver Function. Hepatobiliary scintigraphy (HBS) has been validated as a tool to assess total and regional Liver Function in Liver surgery. It is also used to assess segmental Liver Function before and after portal vein embolization. HBS is considered a valuable quantitative Liver Function test enabling assessment of segmental Liver Function recovery after regional intervention and determination of future remnant Liver Function. We present two cases in which HBS was used to monitor total and regional Liver Function in a patient after repeated whole Liver SIRT complicated with REILD and a patient treated unilaterally without complications.
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Physiological and biochemical basis of clinical Liver Function tests: a review
Annals of surgery, 2013Co-Authors: Lisette T. Hoekstra, Roelof J. Bennink, Wilmar De Graaf, Geert A. A. Nibourg, Michal Heger, Bruno Stieger, Thomas M. Van GulikAbstract:OBJECTIVE: To review the literature on the most clinically relevant and novel Liver Function tests used for the assessment of hepatic Function before Liver surgery. BACKGROUND: Postoperative Liver failure is the major cause of mortality and morbidity after partial Liver resection and develops as a result of insufficient remnant Liver Function. Therefore, accurate preoperative assessment of the future remnant Liver Function is mandatory in the selection of candidates for safe partial Liver resection. METHODS: A MEDLINE search was performed using the key words "Liver Function tests," "Functional studies in the Liver," "compromised Liver," "physiological basis," and "mechanistic background," with and without Boolean operators. RESULTS: Passive Liver Function tests, including biochemical parameters and clinical grading systems, are not accurate enough in predicting outcome after Liver surgery. Dynamic quantitative Liver Function tests, such as the indocyanine green test and galactose elimination capacity, are more accurate as they measure the elimination process of a substance that is cleared and/or metabolized almost exclusively by the Liver. However, these tests only measure global Liver Function. Nuclear imaging techniques ((99m)Tc-galactosyl serum albumin scintigraphy and (99m)Tc-mebrofenin hepatobiliary scintigraphy) can measure both total and future remnant Liver Function and potentially identify patients at risk for postresectional Liver failure. CONCLUSIONS: Because of the complexity of Liver Function, one single test does not represent overall Liver Function. In addition to computed tomography volumetry, quantitative Liver Function tests should be used to determine whether a safe resection can be performed. Presently, (99m)Tc-mebrofenin hepatobiliary scintigraphy seems to be the most valuable quantitative Liver Function test, as it can measure multiple aspects of Liver Function in, specifically, the future remnant Liver.
Patrick H. Alizai - One of the best experts on this subject based on the ideXlab platform.
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Noninvasive Evaluation of Liver Function in Morbidly Obese Patients
Gastroenterology research and practice, 2019Co-Authors: Patrick H. Alizai, Isabella Lurje, Andreas Kroh, Sophia Schmitz, Tom Luedde, Julia Andruszkow, Ulf P. Neumann, Florian UlmerAbstract:Background. More than half of the obese patients develop nonalcoholic fatty Liver disease (NAFLD), which may further progress to nonalcoholic steatohepatitis (NASH) and cirrhosis. The aim of this study was to assess alterations in Liver Function in obese patients with a noninvasive Liver Function test. Methods. In a prospective cohort study 102 morbidly obese patients undergoing bariatric surgery were evaluated for their Liver Function. Liver Function capacity was determined by the LiMAx® test (enzymatic capacity of cytochrome P450 1A2). Liver biopsy specimens were obtained intraoperatively and classified according to the NAFLD Activity Score (NAS). NASH clinical score was additionally calculated from laboratory and clinical parameters. Results. Median Liver Function capacity was 286 ( ) μg/kg/h. 27% of patients were histologically categorized as definite NASH, 39% as borderline, and 34% as not NASH. A significant correlation was observed between Liver Function capacity and NAS ( ; ). The sensitivity and specificity of the LiMAx® test to distinguish between definite NASH and not NASH were 85.2% and 82.9% (AUROC 0.859), respectively. According to the NASH clinical scoring system, 14% were classified as low risk, 31% as intermediate, 26% as high, and 29% as very high risk. Liver Function capacity is also significantly correlated with the NASH clinical scoring system ( ; ). Conclusions. Obese patients show a diminished Liver Function capacity, especially those suffering from type 2 diabetes. The Liver Function capacity correlates with histological and clinical scoring systems. The LiMAx® test may be a valuable tool for noninvasive screening for NASH in obese patients.
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Noninvasive Evaluation of Liver Function in Morbidly Obese Patients
Hindawi Limited, 2019Co-Authors: Patrick H. Alizai, Isabella Lurje, Andreas Kroh, Sophia Schmitz, Tom Luedde, Julia Andruszkow, Ulf P. Neumann, Florian UlmerAbstract:Background. More than half of the obese patients develop nonalcoholic fatty Liver disease (NAFLD), which may further progress to nonalcoholic steatohepatitis (NASH) and cirrhosis. The aim of this study was to assess alterations in Liver Function in obese patients with a noninvasive Liver Function test. Methods. In a prospective cohort study 102 morbidly obese patients undergoing bariatric surgery were evaluated for their Liver Function. Liver Function capacity was determined by the LiMAx® test (enzymatic capacity of cytochrome P450 1A2). Liver biopsy specimens were obtained intraoperatively and classified according to the NAFLD Activity Score (NAS). NASH clinical score was additionally calculated from laboratory and clinical parameters. Results. Median Liver Function capacity was 286 (IQR=141) μg/kg/h. 27% of patients were histologically categorized as definite NASH, 39% as borderline, and 34% as not NASH. A significant correlation was observed between Liver Function capacity and NAS (r=−0.492; p
Ulf P. Neumann - One of the best experts on this subject based on the ideXlab platform.
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Noninvasive Evaluation of Liver Function in Morbidly Obese Patients
Gastroenterology research and practice, 2019Co-Authors: Patrick H. Alizai, Isabella Lurje, Andreas Kroh, Sophia Schmitz, Tom Luedde, Julia Andruszkow, Ulf P. Neumann, Florian UlmerAbstract:Background. More than half of the obese patients develop nonalcoholic fatty Liver disease (NAFLD), which may further progress to nonalcoholic steatohepatitis (NASH) and cirrhosis. The aim of this study was to assess alterations in Liver Function in obese patients with a noninvasive Liver Function test. Methods. In a prospective cohort study 102 morbidly obese patients undergoing bariatric surgery were evaluated for their Liver Function. Liver Function capacity was determined by the LiMAx® test (enzymatic capacity of cytochrome P450 1A2). Liver biopsy specimens were obtained intraoperatively and classified according to the NAFLD Activity Score (NAS). NASH clinical score was additionally calculated from laboratory and clinical parameters. Results. Median Liver Function capacity was 286 ( ) μg/kg/h. 27% of patients were histologically categorized as definite NASH, 39% as borderline, and 34% as not NASH. A significant correlation was observed between Liver Function capacity and NAS ( ; ). The sensitivity and specificity of the LiMAx® test to distinguish between definite NASH and not NASH were 85.2% and 82.9% (AUROC 0.859), respectively. According to the NASH clinical scoring system, 14% were classified as low risk, 31% as intermediate, 26% as high, and 29% as very high risk. Liver Function capacity is also significantly correlated with the NASH clinical scoring system ( ; ). Conclusions. Obese patients show a diminished Liver Function capacity, especially those suffering from type 2 diabetes. The Liver Function capacity correlates with histological and clinical scoring systems. The LiMAx® test may be a valuable tool for noninvasive screening for NASH in obese patients.
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Noninvasive Evaluation of Liver Function in Morbidly Obese Patients
Hindawi Limited, 2019Co-Authors: Patrick H. Alizai, Isabella Lurje, Andreas Kroh, Sophia Schmitz, Tom Luedde, Julia Andruszkow, Ulf P. Neumann, Florian UlmerAbstract:Background. More than half of the obese patients develop nonalcoholic fatty Liver disease (NAFLD), which may further progress to nonalcoholic steatohepatitis (NASH) and cirrhosis. The aim of this study was to assess alterations in Liver Function in obese patients with a noninvasive Liver Function test. Methods. In a prospective cohort study 102 morbidly obese patients undergoing bariatric surgery were evaluated for their Liver Function. Liver Function capacity was determined by the LiMAx® test (enzymatic capacity of cytochrome P450 1A2). Liver biopsy specimens were obtained intraoperatively and classified according to the NAFLD Activity Score (NAS). NASH clinical score was additionally calculated from laboratory and clinical parameters. Results. Median Liver Function capacity was 286 (IQR=141) μg/kg/h. 27% of patients were histologically categorized as definite NASH, 39% as borderline, and 34% as not NASH. A significant correlation was observed between Liver Function capacity and NAS (r=−0.492; p
Julia Andruszkow - One of the best experts on this subject based on the ideXlab platform.
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Noninvasive Evaluation of Liver Function in Morbidly Obese Patients
Gastroenterology research and practice, 2019Co-Authors: Patrick H. Alizai, Isabella Lurje, Andreas Kroh, Sophia Schmitz, Tom Luedde, Julia Andruszkow, Ulf P. Neumann, Florian UlmerAbstract:Background. More than half of the obese patients develop nonalcoholic fatty Liver disease (NAFLD), which may further progress to nonalcoholic steatohepatitis (NASH) and cirrhosis. The aim of this study was to assess alterations in Liver Function in obese patients with a noninvasive Liver Function test. Methods. In a prospective cohort study 102 morbidly obese patients undergoing bariatric surgery were evaluated for their Liver Function. Liver Function capacity was determined by the LiMAx® test (enzymatic capacity of cytochrome P450 1A2). Liver biopsy specimens were obtained intraoperatively and classified according to the NAFLD Activity Score (NAS). NASH clinical score was additionally calculated from laboratory and clinical parameters. Results. Median Liver Function capacity was 286 ( ) μg/kg/h. 27% of patients were histologically categorized as definite NASH, 39% as borderline, and 34% as not NASH. A significant correlation was observed between Liver Function capacity and NAS ( ; ). The sensitivity and specificity of the LiMAx® test to distinguish between definite NASH and not NASH were 85.2% and 82.9% (AUROC 0.859), respectively. According to the NASH clinical scoring system, 14% were classified as low risk, 31% as intermediate, 26% as high, and 29% as very high risk. Liver Function capacity is also significantly correlated with the NASH clinical scoring system ( ; ). Conclusions. Obese patients show a diminished Liver Function capacity, especially those suffering from type 2 diabetes. The Liver Function capacity correlates with histological and clinical scoring systems. The LiMAx® test may be a valuable tool for noninvasive screening for NASH in obese patients.
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Noninvasive Evaluation of Liver Function in Morbidly Obese Patients
Hindawi Limited, 2019Co-Authors: Patrick H. Alizai, Isabella Lurje, Andreas Kroh, Sophia Schmitz, Tom Luedde, Julia Andruszkow, Ulf P. Neumann, Florian UlmerAbstract:Background. More than half of the obese patients develop nonalcoholic fatty Liver disease (NAFLD), which may further progress to nonalcoholic steatohepatitis (NASH) and cirrhosis. The aim of this study was to assess alterations in Liver Function in obese patients with a noninvasive Liver Function test. Methods. In a prospective cohort study 102 morbidly obese patients undergoing bariatric surgery were evaluated for their Liver Function. Liver Function capacity was determined by the LiMAx® test (enzymatic capacity of cytochrome P450 1A2). Liver biopsy specimens were obtained intraoperatively and classified according to the NAFLD Activity Score (NAS). NASH clinical score was additionally calculated from laboratory and clinical parameters. Results. Median Liver Function capacity was 286 (IQR=141) μg/kg/h. 27% of patients were histologically categorized as definite NASH, 39% as borderline, and 34% as not NASH. A significant correlation was observed between Liver Function capacity and NAS (r=−0.492; p
