Alterations in Serum Proteins as an Index of Liver Failure

Abstract

For the past two years we have been interested in the study of the blood proteins in known or suspected cases of liver injury. That there is an alteration in the blood proteins in liver injury has been known since Glenet 1 showed a reduction of the total protein and numerous studies established that there was an elevation of the serum globulin (Felinski 2 ) and a reversal of the albumin globulin ratio in cirrhosis of the liver with ascites (Abrami and Wallach 3 ). Wiener and Wiener 4 obtained a reversal of the A/G ratio in cirrhosis and a hyperglobulinemia in acute infections. Meyers and Keefer 5 and Snell, 6 in cases of decompensated cirrhosis could not attribute the depletion of the serum albumin to its loss in the ascitic fluid.

Serum albumin, serum globulin and total serum protein determinations were made according to the hypobromite gasometric method of Van Slyke in cases of decompensated cirrhosis, cases with choluric jaundice, both intrahepatic and extrahepatic, without ascites, cases of ascites without clinical cirrhosis, a miscellaneous contrast group as well as a control group of normals. These normals served as a check on our technique and established values comparable to the accepted normal values of Peters and Van Slyke.

In 21 cases of decompensated cirrhosis there was a constant hypoalbuminemia and a hyperglobulinemia with a consequent reversal of the A-G ratio, with an average ratio of 0.55 instead of the normal average of 2.48. In no case was paracentesis performed prior to the serum protein determinations. Of particular interest as evidence of the prognostic significance was the duration of life after the serum proteins had undergone these changes. In one instance, for example, in which the serum albumin was 2.3 g. the globulin 5.46, the A-G ratio 0.4, the duration of life was 5 days. The maximum duration of life with pronounced reversal was 70 days.