Changes of laboratory variables with time in cirrhosis: Prognostic and therapeutic significance

Authors

  • Erik Christensen M.D.,

    Corresponding author
    1. Medical Department A, Division of Hepatology, Rigshospitalet; Medical Department, Division of Hepatology and Department of Pathology, Hvidovre Hospital, University of Copenhagen; Medical Departments B and C, Bispebjerg Hospital; Medical Department B, Frederiksberg Hospital, and Medical Departments II, III and VII, Kommunehospitalet, Copenhagen, Denmark; and University Institute of Pathological Anatomy, Århus, Denmark
    • Department of Hepatology 233, Hvidovre Hospital, University of Copenhagen, DK-2650 Copenhagen Hvidovre, Denmark
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  • Poul Schlichting,

    1. Medical Department A, Division of Hepatology, Rigshospitalet; Medical Department, Division of Hepatology and Department of Pathology, Hvidovre Hospital, University of Copenhagen; Medical Departments B and C, Bispebjerg Hospital; Medical Department B, Frederiksberg Hospital, and Medical Departments II, III and VII, Kommunehospitalet, Copenhagen, Denmark; and University Institute of Pathological Anatomy, Århus, Denmark
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  • Lis Fauerholdt,

    1. Medical Department A, Division of Hepatology, Rigshospitalet; Medical Department, Division of Hepatology and Department of Pathology, Hvidovre Hospital, University of Copenhagen; Medical Departments B and C, Bispebjerg Hospital; Medical Department B, Frederiksberg Hospital, and Medical Departments II, III and VII, Kommunehospitalet, Copenhagen, Denmark; and University Institute of Pathological Anatomy, Århus, Denmark
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  • Erik Juhl,

    1. Medical Department A, Division of Hepatology, Rigshospitalet; Medical Department, Division of Hepatology and Department of Pathology, Hvidovre Hospital, University of Copenhagen; Medical Departments B and C, Bispebjerg Hospital; Medical Department B, Frederiksberg Hospital, and Medical Departments II, III and VII, Kommunehospitalet, Copenhagen, Denmark; and University Institute of Pathological Anatomy, Århus, Denmark
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  • Hemming Poulsen,

    1. Medical Department A, Division of Hepatology, Rigshospitalet; Medical Department, Division of Hepatology and Department of Pathology, Hvidovre Hospital, University of Copenhagen; Medical Departments B and C, Bispebjerg Hospital; Medical Department B, Frederiksberg Hospital, and Medical Departments II, III and VII, Kommunehospitalet, Copenhagen, Denmark; and University Institute of Pathological Anatomy, Århus, Denmark
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  • Niels Tygstrup

    1. Medical Department A, Division of Hepatology, Rigshospitalet; Medical Department, Division of Hepatology and Department of Pathology, Hvidovre Hospital, University of Copenhagen; Medical Departments B and C, Bispebjerg Hospital; Medical Department B, Frederiksberg Hospital, and Medical Departments II, III and VII, Kommunehospitalet, Copenhagen, Denmark; and University Institute of Pathological Anatomy, Århus, Denmark
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  • Members of the Copenhagen Study Group for Liver Diseases are: J. T. Balsløv; M. Bjørneboe; P. Christoffersen; K. Eghøje; V. Faber; S. Gjørup; B. Harvald; K. Iversen; O. Jessen; E. Juhl; H. E. Jørgensen; A. R. Krogsgaard; S. A. Nørregaard; T. Steen Olsen; H. Poulsen; F. Quaade; L. Ranek; F. Raaschou; Å. C. Thomsen; N. Tygstrup, and P. Winkel.

Abstract

The time change of laboratory variables in cirrhosis was studied by analysis of data from 488 patients with cirrhosis included in a controlled clinical trial of long-term prednisone vs. placebo.

In the placebo group, a marked regression towards normal was seen within 3 months of entry into the trial (increase in serum albumin, acetylcholinesterase, cholesterol, hemoglobin and decrease in erythrocyte sedimentation rate). The subsequent course did not show a clear pattern, except for a slight increase in serum bilirubin and decrease in albumin. When studied in relation to the time of death in patients dying from a “hepatic” cause, marked increase in bilirubin and decrease in prothrombin index, albumin and cholesterol were seen in the year prior to death with little change before that time.

In the prednisone group, a more marked decrease in bilirubin, SGOT, alkaline phosphatase, γ-globulin, sulfobromophthalein retention, erythrocyte sedimentation rate and increase in leukocytes, prothrombin index and cholesterol were seen during the first 3 months. In relation to time of death from a “hepatic” cause, similar changes were seen as in the placebo group except that alkaline phosphatase increased and cholesterol did not decrease.

A beneficial effect of prednisone on survival, as expressed by a previously developed therapeutic index, was associated with decrease in SGOT, alkaline phosphatase and γ-globulin within the first 3 months. An increase in SGOT during prednisone seemed to be associated with harmful effects of therapy.

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