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Correlation of caffeine elimination and child's classification in liver cirrhosis

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Summary

Apparent pharmacokinetic parameters of caffeine elimination from the circulation were determined in 27 patients with histologically confirmed liver cirrhosis, 8 patients with miscellaneous liver disease, and 8 patients with other than liver disease. The usefullness of this quantitative test to assess the severity of liver cirrhosis was compared to the Child-Turcotte or Child-Pugh classification score as well as to the galactose elimination capacity of these patients. Using reversed-phase high pressure liquid chromatography caffeine, paraxanthine, theophylline, and theobromine were analysed in blood plasma collected before and after an oral dose of caffeine. Compared to apparent caffeine pharmacokinetics in patients with normal livers or miscellaneous liver disease, cirrhosis was characterized by a statistically significant reduction in apparent caffeine clearance and prolongation in half-life. The reduced apparent plasma disappearance rate of caffeine in cirrhotics was related to the retarded formation of paraxanthine which was the main metabolite of caffeine in blood plasma both in the absence or presence of liver disease. The apparent caffeine clearance in cirrhosis decreased with increasing Child-Turcotte classification score: Child's class A patients differed significantly from Child's class B or Child's class C patients, whereas the difference between Child's class B and C patients did not reach statistical significance (Wilcoxon's rank test). In addition there was a strong correlation between the Child-Pugh classification score and apparent caffeine clearance (P<0.001). However, no correlation existed between Child's classification and galactose elimination capacity. Our data emphasize the value of the Child-Turcotte or Child-Pugh classification in assessing the severity of liver cirrhosis in a simpler and less time-consuming way than using quantitative liver function tests.

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Abbreviations

AUC:

Area under curve

Cl:

apparent caffeine clearance

GEC:

galactose elimination capacity

V0 :

distribution volume

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Authors and Affiliations

  1. Abteilung Innere Medizin, Albert-Ludwigs-Universität, Freiburg

    A. Holstege, M. Staiger, K. Haag & W. Gerok

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  1. A. Holstege
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  2. M. Staiger
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  3. K. Haag
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  4. W. Gerok
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Dedicated to Prof. G.-W. Löhr on the occasion of his 65th birthday

Supported by SFB 154 “Klinische und experimentelle Hepatologie”

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Holstege, A., Staiger, M., Haag, K. et al. Correlation of caffeine elimination and child's classification in liver cirrhosis. Klin Wochenschr 67, 6–15 (1989). https://doi.org/10.1007/BF01736528

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  • DOI: https://doi.org/10.1007/BF01736528

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