What are the typical liver function lab abnormalities in late-stage cirrhosis?

From the Guidelines

In late-stage cirrhosis, typical liver function abnormalities include elevated bilirubin, decreased albumin, and prolonged prothrombin time or increased INR, which are key components of the Model for End-Stage Liver Disease (MELD) score, as noted in the 2021 study by the National Comprehensive Cancer Network 1. These abnormalities reflect the liver's diminished synthetic function, impaired detoxification capabilities, and portal hypertension that characterize end-stage liver disease. Some key lab abnormalities include:

• Elevated bilirubin (often >3 mg/dL)
• Decreased albumin (<3.5 g/dL)
• Prolonged prothrombin time or increased INR (>1.5)
• Transaminases (AST and ALT) may be only mildly elevated or even normal
• Alkaline phosphatase and gamma-glutamyl transferase (GGT) are typically elevated, reflecting cholestasis
• Platelet count is often decreased (<150,000/μL) due to splenic sequestration from portal hypertension, as discussed in the 2021 study by the American Association for the Study of Liver Diseases 1
• Ammonia levels may be elevated, contributing to hepatic encephalopathy
• Sodium levels may be low (<135 mEq/L) due to impaired water excretion The MELD score, which incorporates bilirubin, creatinine, and INR, is used to assess disease severity and prioritize patients for liver transplantation, with the most recent guidance provided by the 2021 study 1. Additionally, the 2019 study by the American Gastroenterological Association 1 highlights the limitations of traditional laboratory measures of hemostasis, such as prothrombin time and international normalized ratio, in evaluating patients with cirrhosis, and suggests alternative means of assessing hemostatic pathways, such as viscoelastic tests. However, the MELD score remains the most widely used and accepted tool for assessing liver disease severity and prioritizing patients for liver transplantation, as supported by the 2021 study by the National Comprehensive Cancer Network 1.

From the Research

Liver Function Lab Abnormalities in Late-Stage Cirrhosis

Typical liver function lab abnormalities in late-stage cirrhosis include:

• Elevated serum bilirubin levels 2, 3
• Abnormal liver enzymes, such as alanine aminotransferase (ALT) and aspartate aminotransferase (AST) 3
• Elevated serum alkaline phosphatase (ALP) and gamma glutamyl transpeptidase (GGT) 3
• Low serum albumin levels 4, 5, 3
• Prolonged prothrombin time (PT) 4, 6, 3
• International normalized ratio (INR) abnormalities 4, 6

Quantitative Liver Function Tests

Quantitative liver function tests, such as:

• Indocyanine clearance tests (ICG-K) 3
• Methacetin breath test (MBT) 3
• [14C]aminopyrine breath test (ABT) 5
• Monoethylglycinexylidide test (MEGX) 5 can provide additional information on liver function, but may have limitations and variable availability 3

Assessment of Liver Function

Assessment of liver function in cirrhosis should include a combination of:

• Structural assessment using imaging techniques 3
• Functional assessment using liver function tests 3
• Haemodynamic assessment of portal hypertension 3 Various indices, such as the Model for End-Stage Liver Disease (MELD) score and the Child-Turcotte-Pugh score, can be used to assess liver function in clinical practice 3