Enzymatic liver function capacity correlates with disease severity of patients with liver cirrhosis: a study with the LiMAx test

Dig Dis Sci. 2014 Dec;59(12):2983-91. doi: 10.1007/s10620-014-3250-z. Epub 2014 Jul 4.


Background: Assessment and quantification of actual liver function is crucial in patients with chronic liver disease to monitor disease progression and predict individual prognosis. Mathematical models, such as model for end-stage liver disease, are used for risk stratification of patients with chronic liver disease but do not include parameters that reflect the actual functional state of the liver.

Aim: We aimed to evaluate the potential of a (13)C-based liver function test as a stratification tool by comparison with other liver function tests and clinical parameters in a large sample of healthy controls and cirrhotic patients.

Methods: We applied maximum liver function capacity (LiMAx) to evaluate actual liver function in 347 patients with cirrhosis and in 86 controls.

Results: LiMAx showed strong negative correlation with Child-Pugh Score (r = -0.707; p < 0.001), MELD (r = -0.686; p < 0.001) and liver function tests. LiMAx was lower in patients with liver cirrhosis compared to healthy controls [99 (57-160) µg/kg/h vs. 412 (365-479) µg/kg/h, p < 0.001] and differed among Child-Pugh classes [a: 181 (144-227) µg/kg/h, b: 96 (62-132) µg/kg/h and c: 52 (37-81) µg/kg/h; p < 0.001]. When stratified patients according to disease severity, LiMAx results were not different between cirrhotic patients and cirrhotic patients with transjugular intrahepatic portosystemic shunt.

Conclusions: LiMAx appears to provide reliable information on remnant enzymatic liver function in chronic liver disease and allows graduation of disease severity.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Biomarkers
  • Carbon Isotopes / metabolism
  • Case-Control Studies
  • Female
  • Humans
  • Liver / enzymology*
  • Liver Cirrhosis / enzymology*
  • Liver Cirrhosis / pathology
  • Liver Function Tests / methods*
  • Male
  • Middle Aged
  • Young Adult


  • Biomarkers
  • Carbon Isotopes