Quantitative Correlation of Morphologic Liver Changes and Clinical Tests

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Abstract
The histologic findings in 257 biopsies of liver tissue from 198 patients were compared with the results of a series of hepatic tests performed at the same time as the tissue was removed from the liver for biopsy. The degree of morphologically recognizable liver cell damage was statistically correlated with the degree of abnormality in the results of the hepatic tests using the t value and the chi-square formula. The degree of liver cell damage showed statistically significant correlation with increase in cephalin flocculation, thymol turbidity, total and direct bilirubin and with decrease in albumin and album in-globulin ratio. Elevation of the alkaline phosphatase and urinary urobilinogen, prothrombin time percentage, sedimentation rate and total serum choleserol revealed no significant correlation. Alkaline phosphatase was elevated and urobilinogen reduced by biliary obstruction, independent of liver cell damage. The association of liver cell damage with decrease in albumin is explained by formation of the latter in the liver cells. The correlation of morphologic change with increase in globulin, however, is explained by mesenchymal (chiefly Kupffer cell) reaction that is associated with many forms of hepatocellular injuries, the chief exception being extrahepatic biliary obstruction without infection. This accounts not only for the usually close correlation of the results of the flocculation tests with the degree of liver cell damage but also for the normal results in the flocculation tests in non-infected extrahepatic biliary obstruction, even in the presence of severe liver cell damage. This fact makes the flocculation tests especially valuable in the differential diagnosis between surgical and medical jaundice. However, the tests become positive if secondary bacterial infection complicates extrahepatic biliary obstruction. The number of hepatic tests with abnormal results, independent of their physiologic basis, increases with the degree of liver cell damage. For screening for liver cell damage a combination of the cephalin flocculation test and of detn. of urinary urobilinogen is of value in that positive results indicate liver cell damage while negative results do not exclude it in presence of biliary obstruction.