Earl Hill

An evaluation of factors influencing the discriminative effectiveness of a group of liver function tests. III. Relative effectiveness of hepatic tests in cirrhosis.

Summary An evaluation has been made of the relative effectiveness of nine representative liver function tests in differentiating between a group of patients with cirrhosis and a group of normal subjects. The Bromsulfalein test was the most effective single test. The intravenous galactose tolerance and hippuric acid tests were approximately three-fourths as effective as the Bromsulfalein test; the zinc sulfate turbidity, 24-hour urine coproporphyrin, and per cent cholesterol ester tests were approximately three-fifths as effective; and the 24-hour urine urobilinogen, thymol turbidity, and total serum bilirubin tests were approximately two-fifths as effective. After allowing for interdependence among the tests, only four tests—the Bromsulfalein, zinc turbidity, hippuric acid, and urine coproporphyrin—were found to contribute independently to the discrimination between the normal and cirrhotic groups. The other five tests made little contribution beyond that already represented in the four independently significant tests. A weighted linear combination of these four tests, called the cirrhosis abnormality score, was significantly, though not greatly, more effective than the Bromsulfalein test alone for purposes of group distinction. It also misclassified fewer abnormal individuals. The independent contribution of the Bromsulfalein test to the optimal combination was one and one-half times that of the coproporphyrin test and two and one-half times that of the zinc turbidity and hippuric acid tests.

An Evaluation of Factors Influencing the Discriminative Effectiveness of a Group of Liver Function Tests

Summary The nature of the interrelationships among nine liver function tests in acute viral hepatitis has been studied in detail. As a group the highest intercorrelations among the tests were observed with the urine coproporphyrin and per cent cholesterol esters, the lowest with the zinc sulfate turbidity and urine urobilinogen tests. The observed effectiveness of each test in differentiating between hepatitis patients and normal individuals was wholly dependent upon factors accounting for the independent significance of four tests-the Bromsulf alein, zinc turbidity, hippuric acid, and urine coproporphyrin tests. Coproporphyrin factors contributed the largest amount to the observed eff ectivenes of the total bilirubin, thymol turbidity, per cent cholesterol esters, galactose tolerance, and urine urobilinogen tests. They also contributed significantly to the effectiveness of the Bromsulfalein and hippuric acid tests, but were relatively independent of the zinc turbidity test. Factors accounting for the independent significance of the hippuric acid test contributed appreciably to the observed effectiveness of each of the other tests, though less extensively than the coproporphyrin factors in all instances except that involving the zinc turbidity test. Bromsulfalein factors were most important in determining the observed effectiveness of the hippuric acid test. Though being of secondary importance, they also contributed significantly to the observed effectiveness of the galactose tolerance, per cent cholesterol esters, and urine coproporphyrin tests. All but two of the tests were relatively independent of zinc turbidity factors. The same four sets of basic physiologic factors are involved in both acute hepatitis and cirrhosis; however, the relative importance of each set differs greatly. In cirrhosis, the set of factors accounting for the independent significance of the Bromsulf alein test are by far of greatest importance. In acute hepatitis, the set of factors accounting for the independent significance of the urine coproporphyrin test are most important.

An Evaluation of Factors Influencing the Discriminative Effectiveness of a Group of Liver Function Tests: VI. Nature of the Interrelationships Among Hepatic Tests in Viral Hepatitis

Summary The nature of the interrelationships among nine liver function tests in acute viral hepatitis has been studied in detail. As a group the highest intercorrelations among the tests were observed with the urine coproporphyrin and per cent cholesterol esters, the lowest with the zinc sulfate turbidity and urine urobilinogen tests. The observed effectiveness of each test in differentiating between hepatitis patients and normal individuals was wholly dependent upon factors accounting for the independent significance of four tests-the Bromsulf alein, zinc turbidity, hippuric acid, and urine coproporphyrin tests. Coproporphyrin factors contributed the largest amount to the observed eff ectivenes of the total bilirubin, thymol turbidity, per cent cholesterol esters, galactose tolerance, and urine urobilinogen tests. They also contributed significantly to the effectiveness of the Bromsulfalein and hippuric acid tests, but were relatively independent of the zinc turbidity test. Factors accounting for the independent significance of the hippuric acid test contributed appreciably to the observed effectiveness of each of the other tests, though less extensively than the coproporphyrin factors in all instances except that involving the zinc turbidity test. Bromsulfalein factors were most important in determining the observed effectiveness of the hippuric acid test. Though being of secondary importance, they also contributed significantly to the observed effectiveness of the galactose tolerance, per cent cholesterol esters, and urine coproporphyrin tests. All but two of the tests were relatively independent of zinc turbidity factors. The same four sets of basic physiologic factors are involved in both acute hepatitis and cirrhosis; however, the relative importance of each set differs greatly. In cirrhosis, the set of factors accounting for the independent significance of the Bromsulf alein test are by far of greatest importance. In acute hepatitis, the set of factors accounting for the independent significance of the urine coproporphyrin test are most important.

Note on Hepatic Function One to Three Decades After an Episode of Jaundice During Childhood

Summary Hepatic function was evaluated in 14 unselected young men who had had episodes of jaundice during childhood 12 to 31 years prior to testing, and was found to be normal.