To Study the Relationship of Caffeine Elimination and Child's Pugh Classification in Groups of Patients with Liver Cirrhosis

Abstract

Background: Serum Caffeine clearance determination is a useful method to evaluate the severity of liver disease 
and predict short-term survival of cirrhotic patients. Caffeine concentrations correlated well with the score indicating 
the sufficiency of the organ according to Child- Turcotte classification score. It offers another choice for the 
quantitative measurement of liver functional reservoir.  
Objectives: Study is designed to find out the relationship of Caffeine elimination and Child's classification in 
groups of patients with liver cirrhosis. 
Study Design: Cross sectional Study.  
Place and Duration of Study: The study was conducted at the Medical Ward of Services Hospital Lahore from 
July 2004 to December 2004. 
Material and Methods: Forty patients with liver cirrhosis with age range 40-55 years and 20 aged matched normal 
healthy volunteers were enrolled in this study. Patients were taken from the medical ward of Services Hospital 
Lahore. After an overnight fast, the first blood sample was collected at 8 a.m., immediately followed by an oral 
administration of 200 mg Caffeine. Subsequent samples of venous blood were obtained at 8.30 a.m., 9 a.m., 11 a.m., 
2 p.m. and 5 p.m. The Caffeine clearance was determined by reversed-phase high pressure liquid chromatography 
using a Phenomenex Gemini C18 column using a wavelength of 273 nm.  
Results: (Jaundice presented with highest frequency distribution and percentages. This was followed with ascities, 
edema, family history of hepatitis/jaundice and anemia. Ultrasonographic findings showed that in 50% of the 
patients. Other 50% of patients have normal and shrunken liver). 
Caffeine concentration in child class A was significantly decreased at base line (P<0.001), 3 hours (P<0.05), 6 hour 
(P<0.001) and 9 hour (P<0.001) as compared to the controls. In child class B the Caffeine concentration was 
significantly decreased at base line (P<0.001), 3 hours (P>0.05), 6 hour (P<0.001) and 9 hour (P<0.001) as 
compared to the controls. On the other hand in child class C the Caffeine concentration was remaining same as in 
their controls.  
Conclusion: Caffeine clearance could provide a practical assessment of hepatic function in cirrhotic patients. 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.