Amino acid clearance in cirrhosis. A predictor of postoperative morbidity and mortality
R. H. Pearl, G. H. Clowes Jr, S. Bosari, W. V. McDermott, J. O. Menzoian, W. Love and R. L. Jenkins
The central plasma clearance rate of amino acids (CPCR-AA), the ratio of
peripheral amino acid entry rate into blood plasma to arterial amino acid
concentration, was measured preoperatively in 149 noninfected cirrhotic
patients. In 50 survivors of shunting or general surgical procedures, the
mean (+/- SEM) CPCR-AA was 201 +/- 17 mL/m2/min; in 39 subsequent deaths,
the mean ratio was 87 +/- 14 mL/m2/min. Comparing Child's classification
with CPCR-AA reveals the following values: class A (mortality, two of ten
patients) survivors, 152 +/- 23 mL/m2/min; class A deaths, 96 +/- 54
mL/m2/min; class C (mortality, 13 of 19 patients) survivors, 214 +/- 47
mL/m2/min; class C deaths, 101 +/- 13 mL/m2/min. The preoperative CPCR-AA
of 46 patients receiving liver transplants was 91 +/- 9 mL/m2/min; 69% of
these patients survived. Preoperative CPCR-AA values correlated
significantly with rates of hepatic protein synthesis in incubated liver
slices obtained by biopsy at operation in 22 patients. Thus, CPCR-AA
determination is a true liver function test, valuable in predicting
surgical mortality and selecting transplantation or other operations for
cirrhotic patients.
