The nature and prognostic significance of serial amino acid determinations in severe chronic active liver disease.

Serum amino acid levels were determined in 29 patients with severe chronic active liver disease before, during, and after administration of prednisone or placebo and in 22 healthy controls. The pretreatment molar ratio of amino acids was less in patients than in controls (p less than 0.001) and was lower in those with cirrhosis (p less than 0.02). Branched-chain amino acid levels were elevated in patients without cirrhosis (p less than 0.02) but not in those with cirrhosis; aromatic amino acid concentrations were increased in all (p less than 0.01). The ratio improved with remission and predicted behavior after discontinuation of treatment. Patients who deteriorated failed to improve the ratio and those whose ratio improved incompletely relapsed. The ratio correlated with histologic severity and serum concentrations of albumin, bilirubin, and gamma-globulin and not with clinical manifestations of encephalopathy. We conclude that amino acid abnormalities reflect liver dysfunction and that normalization of the molar ratio may have therapeutic and prognostic significance.