Hepatic clearance measured with 99mTc-GSA single-photon emission computed tomography to estimate liver fibrosis

Table 1 Patient characteristics

Variables	n = 78
Age (yr)	66.7 ± 10.3
Gender (male/female)	63/15
HBs-Ag (+/-)	26/52
HCV-Ab (+/-)	21/57
Alcohol abuse (+/-)	10/68
NASH (+/-)	14/64
Diabetes mellitus (+/-)	25/73
Hyperlipidemia (+/-)	18/60
Platelets (× 104/mm3)	16.6 ± 7.0
Prothrombin time (INR)	1.05 ± 0.11
Albumin (g/dL)	4.0 ± 0.6
Total bilirubin (mg/dL)	0.8 ± 0.3
Cholinesterase (U/L)	248 ± 70
Tumor size (cm)	49.6 ± 36.9
Tumor number	1.2 ± 0.5
Tumor vascular invasion (+/-)	21/57
Ishak classification 0/1/2/3/4/5/6	14/11/8/18/4/13/10
MELD score	5.3 ± 1.3
CTP score	5.2 ± 0.2
ICG R15 (%)	11.6 ± 6.0

HBs-Ag: Hepatitis B surface antigen; HCV-Ab: Hepatitis C virus antibody; NASH: Nonalcoholic steatohepatitis; MELD score: Model for end-stage liver disease score; CTP score: Child-Turcotte-Pugh score; ICG R15: Indocyanine green dye retention at 15 min.

Table 2 Correlations between the degree of liver fibrosis and quantitative indices for liver functional reserve

	r	P value
ICG R15	0.330	0.003
HH15	0.272	0.016
LHL15	-0.198	0.083
HC	-0.598	< 0.00001

The degree of liver fibrosis was correlated with ICG R15, HH15, and HC. ICG R15: Indocyanine green dye retention at 15 min; HC: Hepatic clearance.

Table 3 Correlations between quantitative indices for liver functional reserve and conventional liver function tests

	ICG R15		LHL 15		HH 15		HC
	r	P value	r	P value	r	P value	r	P value
Platelets (× 104/mm3)	-0.160	0.161	0.235	0.038	-0.185	0.105	0.348	0.002
Prothrombin time (INR)	0.082	0.473	-0.122	0.289	-0.016	0.888	-0.287	0.011
Albumin (g/dL)	-0.044	0.703	0.263	0.020	-0.123	0.285	0.233	0.040
Total bilirubin (mg/dL)	0.204	0.073	-0.217	0.057	0.289	0.010	-0.345	0.002
Cholinesterase (U/L)	-0.113	0.324	0.221	0.052	-0.263	0.020	0.419	0.0001

LHL15 was correlated with platelet count and albumin level. HH15 was correlated with total bilirubin level and cholinesterase level. HC was correlated with all conventional liver function tests. ICG R15: Indocyanine green dye retention at 15 min; HC: Hepatic clearance.

Table 4 Univariate and multivariate analyses of variables predictive of severe fibrosis

Variable	Severe fibrosis		P value
	Yes (n = 27)	No (n = 51)	Univariate analysis	Multivariate analysis
Gender (male/female)	23/4	Nov-40	0.474
Age (yr)	66.5 ± 10.0	66.8 ± 10.5	0.950
HBs-Ag (+/-)	10/17	16/35	0.616
HCV-Ab (+/-)	10/17	11/40	0.145
Alcohol abuse (+/-)	2/25	8/43	0.301
NASH (+/-)	4/23	10/41	0.602
Platelets (× 104/mm3)	12.7 ± 3.9	18.7 ± 7.4	< 0.001	0.096
Prothrombin time (INR)	1.09 ± 0.12	1.03 ± 0.10	0.032	0.223
Albumin (g/dL)	4.0 ± 0.6	4.1 ± 0.6	0.388
Total bilirubin (mg/dL)	0.9 ± 0.3	0.7 ± 0.3	0.001	0.354
Cholinesterase (U/L)	234 ± 75	255 ± 68	0.229
Tumor size (cm)	3.5 ± 1.6	5.7 ± 4.2	0.042	0.137
Tumor number	1.1 ± 0.4	1.2 ± 0.6	0.543
Tumor vascular invasion (+/-)	5/22	16/35	0.226
MELD score	5.8 ± 1.1	5.1 ± 1.2	0.009
CTP score	5.3 ± 0.6	5.2 ± 0.4	0.685
ICG R15 (%)	14.3 ± 6.1	10.2 ± 5.5	0.019	0.183
LHL 15	0.901 ± 0.044	0.935 ± 0.024	0.042	0.041
HH 15	0.648 ± 0.068	0.556 ± 0.067	0.004	0.053
HC	263.3 ± 90.4	381.1 ± 96.7	< 0.001	0.030

Platelet count, prothrombin time, total bilirubin level, tumor size, MELD score, ICG R15, LHL15, HH15, and HC were significant predictors of severe cirrhosis in the univariate analysis. In the multivariate analysis, HC and LHL15 were the significant independent predictors. HBs-Ag: Hepatitis B surface antigen; HCV-Ab: Hepatitis C virus antibody; NASH: Nonalcoholic steatohepatitis; MELD score: Model for end-stage liver disease score; CTP score: Child-Turcotte-Pugh score; ICG R15: Indocyanine green dye retention at 15 min; HC: Hepatic clearance.