The liver regulates chemical levels in the blood and excretes bile. Bile helps to break down fats, preparing them for further digestion and absorption. All of the blood leaving the stomach and intestines pass through the liver. The liver processes this blood and creates nutrients for the body to use. The body cannot live without a functioning liver. The basic functioning unit in the liver is a “lobule”. Liver function is largely determined by the number of functioning lobules and the blood flow through them. As liver disease progresses, there may be a decrease in the number of functioning lobules, and changes in blood flow to them.
HEPATIQ® -The Ultimate Liver Test™ - provides six indices of liver disease from a single scan: quantitative liver function, steatosis/steatohepatitis, portal hypertension, alcoholic hepatitis, fibrosis stage and variceal size.[1-25]
HEPATIQ is also the only product on the market that precisely and non-invasively quantifies liver function. Other techniques such as biopsies, elastography and blood tests estimate or score liver fibrosis but do not quantify function.
Quantitative liver function (PHM) can be reduced by infections, alcohol and fat buildup that cause the accumulation of fibrosis or scar tissue (whitish regions in the figure). The liver can regenerate new functioning nodules (e.g. the bumps on the surface in the figure), and blood flow to the liver may increase, providing some mitigation.
A large, badly scarred, stiff liver can have normal function (PHM>100) if there are enough functional nodules and adequate blood flow. Once a patient’s PHM drops below 75, they may decompensate, that is, develop clinical problems.[5,6,11,14,19,20,24]
If their PHM falls below 60, they may die if not transplanted soon.[10,15,18] If patients are treated and chronic liver injury is controlled, their PHM may improve. If PHM rises above 75, they may recompensate with recovery from clinical problems.[10,19,20,25]
Function Outperforms Fibrosis
Biopsies, elastography and blood tests estimate or score liver fibrosis. Patient outcomes are determined by residual liver function, not the extent of fibrosis. This was established in the 8 year, prospective, multi-center, NIH sponsored HALT-C trial, which concluded that quantitative liver function may be more accurate than staging fibrosis in predicting clinical outcomes.[5,6]
Subsequent clinical research has further confirmed that function outperforms fibrosis in predicting outcomes. [12,13,16,17,21,22,24]
Better Disease Management
The HEPATIQ indices are used for diagnosis, staging, interventions, and monitoring liver disease progression. They help identify those at risk of outcomes such as ascites, variceal bleeding, hepatic encephalopathy and liver-related death. [5,6,10,11,14,15,16,18,19,20,23,24,25]
Differentials of these indices indicate steatotic liver disease, steatohepatitis, alcoholic hepatitis, cirrhosis, portal hypertension, varices and infiltrative spleen disease. [5,6,8,11,14,16,21,22,23,25]