Better Test for Predicting Mortality in Liver Failure?

Is a methacetin breath test superior to MELD scores in predicting mortality in liver failure?

Liver damage is typically assessed by the MELD (Model for End-stage Liver Disease) score, the clinical evaluation measure used in giving patients priority status for a liver transplant.

In research presented at the International Liver Congress in Barcelona, researchers from India and Israel said a methacetin breath test is superior to MELD in predicting mortality in these patients.

A.K. Choudhury of the Institute of Liver and Biliary Sciences, New Delhi, India and colleagues there and in Jerusalem said a quantitative measure of liver function was more accurate, including its ability to measure improvement in function. The study was a preliminary report on a Phase 2 clinical trial of the test.

After eight hours of fasting, patients had to ingest 75 mg of methacetin followed by breath analysis. The tests were repeated weekly and watched for declining or improving scores.

Their study group included 24 acute on chronic liver failure patients with a mean MELD score at admission of 17.5.

A MELD score of less than 15 and a breath test with percentage dose recovery value of greater than 5%/h were considered as criteria for predicting survival.

Of 22 patients followed for one year, the last breath test at discharge predicted survival accurately in 4 out of 5 patients, but MELD was accurate in only 14 patients of the 22..

An improvement in the breath test score had a high predictive value for one year survival.

Survivors scores improved 29% and the scores of those who died had declined 10%.

“The C-methacetin breath test provides a rapid, real time, easily non-invasive assessment for liver function in acute on chronic liver failure patients unaffected by non-liver confounding factors,” they concluded.