Prospective Assessment of Liver Function by an Enzymatic Liver Function Test to Estimate Short-Term Survival in Patients with Liver Cirrhosis

Dig Dis Sci. 2019 Feb;64(2):576-584. doi: 10.1007/s10620-018-5360-5. Epub 2018 Nov 7.


Background: MELD attempts to objectively predict the risk of mortality of patients with liver cirrhosis and is commonly used to prioritize organ allocation. Despite the usefulness of the MELD, updated metrics could further improve the accuracy of estimates of survival.

Aims: To assess and compare the prognostic ability of an enzymatic 13C-based liver function test (LiMAx) and distinct markers of liver function to predict 3-month mortality of patients with chronic liver failure.

Methods: We prospectively investigated liver function of 268 chronic liver failure patients without hepatocellular carcinoma. Primary study endpoint was liver-related death within 3 months of follow-up. Prognostic values were calculated using Cox proportional hazards and logistic regression analysis.

Results: The Cox proportional hazard model indicated that LiMAx (p < 0.001) and serum creatinine values (p < 0.001) were the significant parameters independently associated with the risk of liver failure-related death. Logistic regression analysis revealed LiMAx and serum creatinine to be independent predictors of mortality. Areas under the receiver-operating characteristic curves for MELD (0.86 [0.80-0.92]) and for a combined score of LiMAx and serum creatinine (0.83 [0.76-0.90]) were comparable.

Conclusions: Apart from serum creatinine levels, enzymatic liver function measured by LiMAx was found to be an independent predictor of short-term mortality risk in patients with liver cirrhosis. A risk score combining both determinants allows reliable prediction of short-term prognosis considering actual organ function. Trial Registration Number (German Clinical Trials Register) # DRKS00000614.

Keywords: End-stage liver disease; LiMAx; Liver function test; MELD; Risk assessment; Survival.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acetamides
  • Breath Tests
  • Carbon Dioxide / analysis
  • Carbon Isotopes
  • Cohort Studies
  • Creatinine / metabolism
  • Cytochrome P-450 CYP1A2 / metabolism
  • End Stage Liver Disease / enzymology*
  • End Stage Liver Disease / metabolism
  • End Stage Liver Disease / mortality
  • Female
  • Humans
  • Liver Cirrhosis / enzymology*
  • Liver Cirrhosis / metabolism
  • Liver Cirrhosis / mortality
  • Liver Function Tests
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Prognosis
  • Proportional Hazards Models
  • Prospective Studies
  • Severity of Illness Index
  • Survival Rate


  • Acetamides
  • Carbon Isotopes
  • methacetin
  • Carbon Dioxide
  • Creatinine
  • Cytochrome P-450 CYP1A2