tion impairment. Coagulation factors, in particular plasma Albumin and fibrinogen synthesis rates were meafibrinogen, can likewise reflect liver function. However, a sured in 15 subjects with different clinical stages of postsubstantial decrease in plasma fibrinogen concentration beviral cirrhosis and compared with galactose elimination cause of liver cirrhosis occurs mainly in end-stage liver failcapacity and aminopyrin breath test. Forty-three mg per ure and has limited predictive value in less advanced stages kg body weight [ 2 H 5 ring]phenylalanine with an isotopic of cirrhosis. 9 enrichment of 10 atom% were intravenously injected.
Recently, we have shown that albumin synthesis rates [ 2 H 5 ring]phenylalanine enrichments in the plasma-free measured by a stable isotope technique strongly correlate phenylalanine and the albumin and fibrinogen isolates with the clinical stage of alcoholic cirrhosis, as judged by were measured by gas chromatography-mass spectromboth the Child-Turcotte and the Child-Pugh scores. 10 In the etry. Fractional synthesis rates of albumin were normal present study, we have extended our observation in a distinct in Child A cirrhosis (7.6 { 2.2 %/d), but were lower in group of patients with nonalcoholic cirrhosis of the liver. In both Child B (3.5 { 0.8 %/d) and C (4.5 { 2.8 %/d). Absolute addition, we have investigated the possible interrelationship rates of albumin synthesis were (103 { 30 mg/kg/d) in between the albumin synthetic rate and both the aminopythe child A group and substantially lower in the Child rine breath test (ABT) and the galactose elimination capacity B (50 { 3 mg/kg/d) and C (36 { 20 mg/kg/d) group. The (GEC) in patients with mainly postviral cirrhosis at different average fractional synthesis rate of fibrinogen was 16.7 clinical stages. { 7.5 %/d and the absolute synthesis rate 11.6 { 6.4 mg/ kg/d. The values of the galactose elimination capacity PATIENTS AND METHODS and the aminopyrin breath test were below the normal range in all patients, gradually decreasing with an in-Fifteen patients, aged 55 { 10 years (range, 37-70 years; 4 females, crease in the severity of the clinical stage of cirrhosis. 11 males) with cirrhosis were consecutively selected from the outpa- Albumin synthesis rates significantly correlated with tient hepatology department for the study. All patients were coming to the hospital for clinical assessment on the day of the investigation. the Child scores, the galactose elimination capacity, and They had no restrictions in food intake but had to produce a 3-day the aminopyrin breath test, whereas fibrinogen syntheweighed dietary record immediately before the investigation. The sis rates showed no such correlations. (HEPATOLOGY patients were instructed by the same dietitian how to record the 1996;24:53-59.)
weights of all food and beverages consumed. They received a demonstration of the use of electronic scales and the dietitian checked the Plasma albumin concentration is a recognized parameter use of the scales. If problems occurred they had the possibility to contact the dietitian during daytime. Later, the intake was analyzed of the clinical follow-up in patients with cirrhosis of the liver.
for energy consumption, protein, and fat intake by a computer pro-It is one of the important criteria of the Child scores 1-5 and gram (Foodcontrol FCI, Zu Β¨rich, Switzerland). Patients with addiis as such a predictive factor of the clinical outcome in pational acute diseases, important chronic diseases, iodine allergy, tients with different stages of cirrhosis. However, many facpregnancy, and malnutrition not explained by the liver disease, were tors such as malnutrition, concomittant acute inflammatory not included in the study. Also, patients treated with interferon a disease, intestinal or renal losses, or an increase in the transin an ongoing protocol for the treatment of chronic viral hepatitis in capillary escape of albumin, 6-8 can cause low plasma albumin the department of hepatology were excluded from the study. concentration, and thus obscure the true extent of liver func-
The patients received 60 mg potassium iodide daily orally starting the day before the investigation and for the following 10 days to block 125 I-uptake by the thyroid gland. On the day of the measurements, after an overnight fast, an intravenous line was inserted Abbreviations: ABT, aminopyrine breath test; GEC, galactose elimination capacity; SDSinto both forearms, and a blood sample was withdrawn for baseline PAGE, sodium dodecylsulfate-polyacrylamide gel electrophoresis; FSR, fractional synthesis laboratory determinations. Between 8 and 9 AM, 43 mg of [ 2 H 5 ring]rate; ASR, absolute sythesis rate.