The 13C-Caffeine Breath Test Detects Significant Fibrosis in Patients With Nonalcoholic Steatohepatitis

• DOI: 10.1097/mcg.0b013e318046ea65
• Publication Date: 2009-03-05T17:23:00Z
• Authors: Hemda Schmilovitz...; Yaron Niv; Orit Pappo; Marisa Halpern; Jacklin Sulkes; Marius Braun; Nir Barak; Yaron Rotman; Maya Cohen; Amal Waked; Ran Tur-Kaspa; Ziv Ben-Ari
• Keywords: Liver Cirrhosis; Male; Carbon Isotopes; Reproducibility of Results; Middle Aged; Prognosis; Severity of Illness Index; 3. Good health; Diagnosis, Differential; Fatty Liver; 03 medical and health sciences; 0302 clinical medicine; Breath Tests; Caffeine; Humans; Female; Follow-Up Studies; Retrospective Studies

The C-caffeine breath test (CBT) is a noninvasive tool for the evaluation of the cytochrome P450 system, implicated in the development of nonalcoholic steatohepatitis.To apply the CBT to assess the extent of hepatic fibrosis in patients with nonalcoholic fatty liver disease (NAFLD).Twenty-six consecutive patients (mean age 56.1+/-6.85 y, 69.2% women) with NAFLD underwent the CBT, in addition to the clinical and laboratory evaluations and liver biopsy. Ten healthy individuals matched for age served as controls.Mean delta over baseline values differed significantly between patients and controls (1.51+/-0.9 vs. 2.37+/-0.8 Delta per thousand/mg, respectively) (P=0.01) and were significantly higher in patients with fibrosis stage <2 (Brunt's system) (2.0+/-0.77 vs. 1.3+/-0.9 for stage > or =2, P=0.05). Mean delta over baseline values correlated highly with fibrosis stage (P=0.01), albumin (P=0.007), international normalized ratio (P=0.04), bilirubin (P=0.0008), and platelet count (P=0.0001). On multivariate stepwise logistic regression analysis, CBT was the best predictor of severe fibrosis (stage > or =2) (odds ratio 0.274, 95% confidence interval 0.086-0.872, P=0.028), with an area under the curve of 0.788.The CBT is safe and easy to perform. It can reliably predict severe hepatic fibrosis in patients with NAFLD. Further large-scale studies are still needed.