Diagnostic and prognostic implications of plasma amino acid determinations in chronic active hepatitis

To further assess the molar ratio of branched-chain to aromatic amino acids as a measure of disease activity, we correlated results of this test with histologic features of inflammation, standard biochemical tests, and prognosis in 68 patients with severe chronic active hepatitis. An abnormal molar ratio (less than 3.0) reflected histologic findings of chronic active hepatitis in 26 of 35 instances. A normal molar ratio (greater than or equal to 3.0), however, was associated with histologic features of chronic active hepatitis in nine of 14 instances. Molar ratio abnormalities occurred more frequently in patients with cirrhosis than without cirrhosis (95% vs 45%, P less than 0.01). Only one of 20 patients with cirrhosis had a normal ratio, and none of 12 followed serially during therapy improved the ratio to normal. No correlation was seen between the molar ratio and severity of inflammation or serum levels of aspartate aminotransferase, albumin, bilirubin, and gamma globulin. When corticosteroids were discontinued, relapse occurred as frequently in patients with a normal molar ratio as in others (80% vs 71%), and the presence of an abnormal ratio did not preclude a sustained remission after treatment. We conclude that the plasma molar ratio does not reflect histologic activity, correlate with standard liver function tests, or indicate disease behavior after treatment withdrawal. A normal molar ratio during or after treatment, however, may exclude cirrhosis.