Enzymatic liver function measured by LiMAx – a reliable diagnostic tool in chronic liver disease

Background:

Chronic liver disease (CLD) is a major cause of morbidity and mortality worldwide. Non-invasive identification of patients with advanced stages of CLD is clinically relevant as it serves as an important determinant in the evaluation of disease progression and long-term outcome.

Patients and Methods:

We retrospectively compared the diagnostic performance of different non-invasive tools (LiMAx, transient elastography (TE), and biomarkers) in detecting different stages occurring during the course of chronic liver disease. Therefore, patients were divided into four groups based on clinical parameters: (1) patients without CLD (control group), (2) patients suffering from CLD without having cirrhosis, (3) patients with CLD and compensated cirrhosis, and finally, (4) patients with CLD and decompensated cirrhosis. Patients with acute liver failure were excluded from the analysis.

Results:

A total of 464 patients who underwent LiMAx measurement at the University Clinic of Essen between 10/2016 and 11/2017 were included in this study. Distribution of the different groups were n = 72 (15.5%) patients for group 1, n = 134 (28.9%) patients for group 2, n = 160 (34.5%) patients for group 3, and n = 98 (21.1%) patients for group 4, respectively. Median LiMAx values significantly declined with respect to increasing degree of chronic liver disease: (1) 510 (411 – 570)µg/h/kg, (2) 390 (343 – 453)µg/h/kg, (3) 264 (215 – 308)µg/h/kg, and (4) 151 (96 – 219)µg/h/kg, p < 0.001. When comparing the diagnostic accuracy of the LiMAx test in detecting patients with presence of cirrhosis (groups 1 and 2 vs. groups 3 and 4), an AUROC of 0.942 was found (cut-off 322 µg/h/kg, sensitivity 86.1%, specificity 91.3%, p < 0.0001), which was superior to TE (cut-off 15 kPa, AUROC of 0.939), FIB-4 score (cut-off 2.63, AUROC of 0.893), AST/ALT ratio (cut-off 1.1, AUROC 0.823), and APRI score (cut-off 0.7, AUROC 0.797), respectively.

Conclusion:

Effective and reliable non-invasive detection of cirrhosis in patients with CLD is clinically relevant in order to permit risk stratification. We herein could demonstrate that enzymatic liver function measured by the LiMAx test was closely associated with different stages occurring during the course of CLD. LiMAx had the highest diagnostic accuracy compared to TE and serum biomarkers in patients with CLD.