The Application Of Indocyanine Green Clearance Test In The Assessment Of End-stage Liver Disease

Background: Liver diseases threat the health of human seriously.Due tostructural and functional complexity, accurate assessment of liver functionreserve is a important for liver disease and the treatment of many otherdiseases At present, the assessing methods of liver function were divided intostatic and dynamic examination.In clinical, static test is the method usedcommonly. But the only static test of liver cannot reflects the dynamicchanges of liver function in time and accurately, and dynamic test canprecisely compensate for the lack of static testing. By combining static anddynamic tests, dynamic assessment is an inevitable trend in the field oftreatment for liver disease. Indocyanine green (ICG) clearance test may betimely, non-invasive liver function testing, and many studies suggest that it isa sensitive method to detect the liver functional reserve of patients withcirrhosis.So indocyanine green clearance test (ICG) is the most widely usedmethod among the dynamic tests of liver. DDG-3300K is used to measure theblood ICG concentration. The ICGR15and K are calculated automaticallyfrom the blood ICG concentration time course.The speed of ICG clearancedepends on the amount of liver cells damaged, the function of liver cells andliver blood flow.So it can be used to assess the amount of liver cells andreflect the liver reserve function.Objective: To investigate the effectiveness of Indocynine greenclearance test for assessing the reserve function of cirrhosis and cancer,todiscuss:(1) the relationship between ICG clearance test and MELD,MELD-Na, MESO, iMELD scores;(2) evaluation of the indocyanine greenclearance test and MELD, MELD-Na, MESO, iMELD scores for estimation of short-term prognosis in decompensated cirrhosis;(3) the relationshipbetween ICG clearance test and liver dysfunction after liver resection.Methods:(1)Collect880patients with chronic liver disease acceptingthe examination of Indocynine green clearance test who were fromhospitalized in First Hospital of Jilin University from May,2009to December,2011, Patients are including648male and152female, average ageis(53.01±6.64). And all cases including453patients with hepatic cirrhosis,427patients with hepatocellular carcinoma,39patients with liver failure. Liverfunction were graded according to Child-Pugh scoring system, which is classA271cases, class B380, class C229cases.According to different causes,453patients with hepatic cirrhosis were classified:276patients with cirrhosisof HBV,86patients with cirrhosis of HCV,91patients with alcoholiccirrhosis.All patients were classified by Child-Pugh grade.The ICG clearancetest (K value and ICGR15) was performed by ICG pulse spectrophotometry(DDG-3300K), and the MELD, MELD-Na, MESO, iMELD scores of patientswere calculated. Correlation analysis between ICG test and those indexeswere conducted.(2) Selecting120cases of patients with alcoholic and viral decompe-nsated cirrhosis (excluding liver cancer),and make prospective study to assessthe short-term prognostic value of among R15and the MELD, the MELD-Na, MESO iMELD score decompensated cirrhosis.(3) Selecting80patients with primary liver cancer were operated in FirstHospital of Jilin University Department of Surgery,and the ICG clearance test(K value and ICGR15) was performed before Surgery,to investigate theoccurrence of postoperative liver dysfunction in different ICG clearance level.Results: Of880patients with chronic liver disease,there are271patientsin Child-Pugh class A,whose average ICGR15were (16.977±11.726)%,average K value were (0.140±0.051)/min;380patients in Child-Pugh B whose average ICGR15were (34.676±16.005)%,average K value were(0.082±0.432)/min;229patients in Child-Pugh C whose average ICGR15were(49.292±11.738)%,average K value were (0.049±0.171)/min. There weresignificant statistical differences in K value, ICGR15and MELD，MELD-Na，MESO， iMELD score in patients with different Child-Pugh groups(P<0.01).As the Child-Pugh classification of liver function gradually deterio-rated, the R15and MELD，MELD-Na，MESO，iMELD score increased,while K value decreased.Significant correlations were found between theparameters of the ICG test and MELD，MELD-Na，MESO，iMELD score.Positive correlation was observed between R15and MELD，MELD-Na，MESO，iMELD score while a negative correlation was observed between Kvalue and MELD，MELD-Na，MESO，iMELD score. And compared with Kvalue, ICGR15showed better correlation，and R15have the best significantcorrelation with iMELD in four end-stage liver disease scores.Among three different causes of cirrhosis, the correlation among K value,the value of R15and the MELD, the MELD-Na, MESO, iMELD score inpatients with alcoholic cirrhosis is better than those in patients with hepatitis Ccirrhosis and hepatitis B cirrhosis. And compared with K value, ICGR15showed better correlation，and R15have the best significant correlation withiMELD in four end-stage liver disease scores.The difference of ages, serum Na, PT, INR, bilirubin, creatinine, R15, theMELD, the MELD-Na, MESO, iMELD score in survival group and deathgroup was statistically significant (P <0.01, P <0.05). In the six monthfollow-up,17patients died, the R15,MELD, the MELD-Na, MESO, iMELDscore in the death group were higher than the survival group those in thesurvival group (P <0.01). The95%confidence intervals with the ROC curve(AUC) of R15and four scoring system have overlap.And found that the AUC of iMELD score is the biggest,whihe the AUC of ICGR15is the smallest.The AUC of R15and the four scoring systems were no significant differences(P>0.05).There are51cases in good group,26cases in mild group,and3cases insevere group of liver function.The biochemical indicators of AST, ALT, TBIL,ALB, the PT, the INR between good group and mild group have no significantdifference(P>0.05).There is no no significant difference (P=0.116) betweenthe Child-Pugh score in two groups.While the difference of ICG clearance testindex K value and R15values between the two groups are statisticallysignificant (P <0.01).According to the R15value to make groups,postoperative liver insufficiency rate was11.1%in group A,40%in groupB,80%in group C.The differences of postoperative liver insufficiency ratebetween groups were statistically significant.Three cases of severe hepaticdysfunction are in group C, the R15value were39.5%,40.5%,46.8%, farhigher than the upper limit of normal of the R15.Conclusion: As the Child-Pugh classification of liverfunction graduallydeteriorated, the ICGR15and MELD、MELD-Na、MESO、iMELD scoreincreased, while K value decreased. Significant correlations were foundbetween the parameters of the ICG test and MELD，MELD-Na，MESO，iMELD score. And compared with K value, ICGR15showed bettercorrelation，and R15have the best significant correlation with iMELD in fourend-stage liver disease scores.Among three different causes of cirrhosis, thecorrelation among K value, the value of R15and the MELD, the MELD-Na,MESO, iMELD score in patients with alcoholic cirrhosis is better than thosein patients with hepatitis C cirrhosis and hepatitis B cirrhosis.The ICGR15andthe MELD, the MELD-Na, MESO, iMELD score can be used to predictshort-term prognosis of patients with decompensated cirrhosis. The score ishigher, the patient’s mortality is higher.The predictive value difference between R15and the four scoring system was not statistically significant. ICGclearance test can accurately assess liver function reserve,and effectivelypredicte liver dysfunction after hepatectomy.