Tests of the liver's biosynthetic capacity (eg, albumin, coagulation factors, prothrombin time)
- Lawrence S Friedman, MD
Lawrence S Friedman, MD
- Section Editor — General Gastroenterology
- Professor of Medicine
- Harvard Medical School
- Tufts University School of Medicine
- Section Editor
- Sanjiv Chopra, MD, MACP
Sanjiv Chopra, MD, MACP
- Editor-in-Chief — Gastroenterology/Hepatology
- Section Editor — General Hepatology
- Section Editor — Gallbladder and Biliary Tract Disease
- Professor of Medicine
- Harvard Medical School
- Senior Consultant in Hepatology
- James Tullis Firm Chief
- Beth Israel Deaconess Medical Center
A number of blood tests are available that reflect the condition of the liver. The most common tests used in clinical practice include the serum aminotransferases, bilirubin, alkaline phosphatase, albumin, and prothrombin time. These tests are often referred to as "liver function tests," although this term is somewhat misleading since most do not accurately reflect how well the liver is functioning, and abnormal values can be caused by diseases unrelated to the liver. In addition, these tests may be normal in patients who have advanced liver disease.
Several specialized tests have also been developed (such as indocyanine green clearance), which, although uncommonly used in clinical practice, can measure specific aspects of hepatic function.
Despite their limitations, liver biochemical and function tests have many applications in clinical medicine:
●They provide a noninvasive method to screen for the presence of liver disease. The serum aminotransferases, for example, were used in the past to screen all blood donors in the United States for the presence of transmissible viruses before specific viral tests were available.
●They can be used to measure the efficacy of treatments for liver disease (such as immunosuppressant agents for autoimmune hepatitis). (See "Autoimmune hepatitis: Treatment".)
- Rothschild MA, Oratz M, Schreiber SS. Serum albumin. Hepatology 1988; 8:385.
- Pietrangelo A, Panduro A, Chowdhury JR, Shafritz DA. Albumin gene expression is down-regulated by albumin or macromolecule infusion in the rat. J Clin Invest 1992; 89:1755.
- Sun X, Martin V, Weiss RH, Kaysen GA. Selective transcriptional augmentation of hepatic gene expression in the rat with Heymann nephritis. Am J Physiol 1993; 264:F441.
- Moshage HJ, Janssen JA, Franssen JH, et al. Study of the molecular mechanism of decreased liver synthesis of albumin in inflammation. J Clin Invest 1987; 79:1635.
- Perlmutter DH, Dinarello CA, Punsal PI, Colten HR. Cachectin/tumor necrosis factor regulates hepatic acute-phase gene expression. J Clin Invest 1986; 78:1349.
- Dinarello CA. Interleukin-1 and the pathogenesis of the acute-phase response. N Engl J Med 1984; 311:1413.
- Rothschild MA, Oratz M, Zimmon D, et al. Albumin synthesis in cirrhotic subjects with ascites studied with carbonate-14C. J Clin Invest 1969; 48:344.
- Lieberman FL, Reynolds TB. Plasma volume in cirrhosis of the liver: its relation of portal hypertension, ascites, and renal failure. J Clin Invest 1967; 46:1297.
- Veldhuyzen van Zanten SJ, Depla AC, Dekker PC, et al. The clinical importance of routine measurement of liver enzymes, total protein and albumin in a general medicine outpatient clinic: a prospective study. Neth J Med 1992; 40:53.
- Mutlu EA, Keshavarzian A, Mutlu GM. Hyperalbuminemia and elevated transaminases associated with high-protein diet. Scand J Gastroenterol 2006; 41:759.
- Tripodi A, Salerno F, Chantarangkul V, et al. Evidence of normal thrombin generation in cirrhosis despite abnormal conventional coagulation tests. Hepatology 2005; 41:553.
- Northup PG, Caldwell SH. Coagulation in liver disease: a guide for the clinician. Clin Gastroenterol Hepatol 2013; 11:1064.
- O'Grady JG, Alexander GJ, Hayllar KM, Williams R. Early indicators of prognosis in fulminant hepatic failure. Gastroenterology 1989; 97:439.
- Hoofnagle JH, Carithers RL Jr, Shapiro C, Ascher N. Fulminant hepatic failure: summary of a workshop. Hepatology 1995; 21:240.
- Robert A, Chazouillères O. Prothrombin time in liver failure: time, ratio, activity percentage, or international normalized ratio? Hepatology 1996; 24:1392.
- Denson KW, Reed SV, Haddon ME, et al. Comparative studies of rabbit and human recombinant tissue factor reagents. Thromb Res 1999; 94:255.
- Deitcher SR. Interpretation of the international normalised ratio in patients with liver disease. Lancet 2002; 359:47.
- Trotter JF, Brimhall B, Arjal R, Phillips C. Specific laboratory methodologies achieve higher model for endstage liver disease (MELD) scores for patients listed for liver transplantation. Liver Transpl 2004; 10:995.
- Tripodi A, Chantarangkul V, Primignani M, et al. The international normalized ratio calibrated for cirrhosis (INR(liver)) normalizes prothrombin time results for model for end-stage liver disease calculation. Hepatology 2007; 46:520.
- Bellest L, Eschwège V, Poupon R, et al. A modified international normalized ratio as an effective way of prothrombin time standardization in hepatology. Hepatology 2007; 46:528.
- Nelsestuen GL, Zytkovicz TH, Howard JB. The mode of action of vitamin K. Identification of gamma-carboxyglutamic acid as a component of prothrombin. J Biol Chem 1974; 249:6347.
- Weitz IC, Liebman HA. Des-gamma-carboxy (abnormal) prothrombin and hepatocellular carcinoma: a critical review. Hepatology 1993; 18:990.