Relationship between 13C-aminopyrine breath test and the MELD score and its long-term prognostic use in patients with cirrhosis

Background: ¹³C-Aminopyrine breath test (¹³C-ABT) is a non-invasive, dynamic, quantitative liver function test, and the model for end-stage liver disease (MELD) is a recognised biochemical score used to predict survival in patients with cirrhosis. Aims: The purpose of this study was to evaluate the relationship between the ¹³C-ABT and MELD score in a cohort of cirrhotic patients and, moreover, to assess the prognostic value of ¹³C-ABT results in the same group of patients. Patients and Methods: Forty-six patients with cirrhosis and without hepatocellular carcinoma who underwent ¹³C-ABT and who had at least 1-year follow-up were prospectively included in this study. MELD score was calculated at entry into the study in all patients. End-points of the study were 1-year liver-related death or liver transplantation. Results: ¹³C-ABT %dose/h at 30 min (%dose/h₃₀) results showed significant, inverse correlation with MELD scores (r = -0.414, P = 0.004). During 1-year follow-up nine patients died (19.6 %) and two were transplanted (4.3 %). Median ¹³C-ABT %dose/h₃₀ results (3.2 vs. 1.8) were significantly higher in patients who survived as compared to those who died or underwent transplantation (P = 0.04). Receiver operating characteristics curves showed that a ¹³C-ABT %dose/h₃₀ cut-off of 2.0 had the best accuracy (c-index = 0.717) in assessing 1-year prognosis. Conclusions: We observed a correlation between a flow-independent quantitative liver function test and the MELD score, and found that the ¹³C-ABT may accurately provide long-term prognostic information in cirrhotic patients.