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Intrinsic hepatic clearance and Child-Turcotte classification for assessment of liver function in cirrhosis

J C Barbare, R E Poupon, P Jaillon

    Journal of Hepatology
    |January 1, 1985
    PubMed

    Insights

    The Child-Turcotte classification (CTC) offers only a general assessment of cirrhosis severity. Direct measurement of intrinsic hepatic clearance (IHC) provides a more accurate evaluation of liver function impairment in cirrhotic patients.

    Area of Science:

    • Hepatology
    • Clinical Biochemistry
    • Medical Diagnostics

    Background:

    • The Child-Turcotte classification (CTC) is a widely used empirical method for assessing cirrhosis severity.
    • The accuracy of CTC in reflecting the precise degree of hepatic function impairment remains uncertain.
    • Standard liver tests and intrinsic hepatic clearance (IHC) are potential indicators of liver function.

    Purpose of the Study:

    • To compare the Child-Turcotte classification (CTC) with standard liver tests and intrinsic hepatic clearance (IHC) for assessing hepatic function in cirrhotic patients.
    • To determine which variables best correlate with and explain the impairment of intrinsic hepatic clearance (IHC) in cirrhosis.

    Main Methods:

    • Sixty-three cirrhotic patients and 10 control patients were studied.
    • Intrinsic hepatic clearance (IHC) of indocyanine green was measured.
    • Standard liver tests including serum bilirubin (SB), prothrombin time (PT), serum albumin, alkaline phosphatase, and ALAT were performed.
    • Clinical criteria of the Child-Turcotte classification (CTC) were assessed.
    • Multivariate analysis was used to identify significant predictors of IHC impairment.

    Main Results:

    • Intrinsic hepatic clearance (IHC) was significantly decreased in cirrhotic patients compared to controls (0.270 +/- 0.141 L/min vs 1.227 +/- 0.312 L/min, P < 0.001).
    • Serum bilirubin (SB) and prothrombin time (PT) were significantly correlated with impaired IHC.
    • Alkaline phosphatase, ALAT, and clinical criteria of CTC did not show significant correlation with IHC.
    • A multivariate model using SB and PT explained 42.6% of the variance in IHC impairment (Z = 21.77 + 4.78 PT - 1.25 SB).

    Conclusions:

    • The Child-Turcotte classification (CTC) provides only a gross estimation of liver function impairment in cirrhosis.
    • Direct measurement of liver function, such as intrinsic hepatic clearance (IHC), is preferable for evaluating prognosis and treatment response in cirrhosis.
    • Serum bilirubin and prothrombin time are key indicators of impaired hepatic function in cirrhotic patients.

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