Noninvasive evaluation of cytochrome c oxidase activity of the liver. Its prognostic value for hepatic resection.

OBJECTIVE

To clarify the relationship between the noninvasive evaluation of hepatic mitochondrial function, the redox tolerance test, and cytochrome c oxidase activity of the liver, focusing on surgical risk in hepatic resection.

DESIGN

Six-month randomized clinical trial.

SETTING

Inpatients in surgical department.

STUDY PARTICIPANTS

Forty patients who underwent hepatic resection (n = 36) and other abdominal operations (n = 4).

INTERVENTION

Preoperative, noninvasive: The redox tolerance test, which measures the changes in arterial ketone body ratio in response to 75 g of oral glucose loading. Intraoperative, invasive: Cytochrome c oxidase activity and energy charge of the liver.

MAIN OUTCOME MEASURE

Correlation of the index in the redox tolerance test (RTI) with cytochrome c oxidase activity, both of which predict the postoperative course.

RESULTS

The RTI values were negatively correlated with the maximal velocity (Vmax) and Michaelis constant (Km) values of cytochrome c oxidase activity. The maximal velocity and Michaelis constant values in patients with RTI values above or equal to 0.5 (group A, n = 29) were significantly lower than those in patients with RTI values below 0.5 (group B, n = 11). Eight (72.7%) of 11 patients in group B experienced postoperative complications.

CONCLUSION

The RTI is a noninvasive method of assessing the hepatic energy metabolism and can be a useful index for evaluating surgical risk in hepatectomy.