TY - JOUR
T1 - Amino Acid Clearance in Cirrhosis
T2 - A Predictor of Postoperative Morbidity and Mortality
AU - Pearl, Richard H.
AU - Clowes, George H A
AU - Bosari, Silvano
AU - Mcdermott, William V.
AU - Menzoian, James O.
AU - Love, Wendy
AU - Jenkins, Roger L.
PY - 1987
Y1 - 1987
N2 - • 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.
AB - • 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.
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U2 - 10.1001/archsurg.1987.01400160094015
DO - 10.1001/archsurg.1987.01400160094015
M3 - Article
C2 - 3551882
AN - SCOPUS:0023145634
VL - 122
SP - 468
EP - 473
JO - Archives of Surgery
JF - Archives of Surgery
SN - 0004-0010
IS - 4
ER -