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• W2014932366 abstract "Two papers in this issue of the Journal of Hepatology evaluate the formation of mono-ethyi-glycine-xylidide (MEGX) from lidocaine as a quantitative test of liver function (1,2). Meyer-Wyss et al. (1) compare the MEGX test with others, namely galactose elimination capacity and the aminopyrine breath test in 111 patients with chronic liver disease of different etiologies and histologic severity. As reported by many previous investigators these authors report a large variability of all three tests within and between groups of histologic severity. In their study the MEGX test was inferior to both the aminopyrine breath test and the galactose elimination capacity in differentiating mild from severe histologic lesions (1). Unlike the second paper, the sensitivity and specificity of the different tests were not calculated and Figs. 1-3 are not convincing evidence of the separating power of any of the tests evaluated. Huang et al. compared the MEGX test in 71 patients with chronic liver disease with 26 normal controls. They also evaluated it against indocyanine green retention, galactose elimination capacity and the Pugh score (2). Using receiver-operator characterization these authors found an accuracy of 86% for the MEGX test at a cutoff value of 54 ng/ml (MEGX serum level at 15 minutes after administration of lidocaine) for differentiating between liver disease and healthy controls and more importantly that a value of less than 30 ng/ml was associated with lower survival probability (Fig. 4 of Ref. 2). Unfortunately, the prognostic value of the other tests was not similarly evaluated. While lidocaine clearance was used as a quantitative liver function test in the past with variable success (3-5), its use never gained widespread acceptance. The MEGX test was proposed by Oellerich and colleagues as another quantitative liver function test (6). This group has repeatedly reported that it gives an accurate prediction of graft survival determination of MEGX formation in the donor (7-8) and short-term survival in adult and pediatric liver transplantation candidates (9-11). Independent confirmation of the prognostic value of the MEGX test has been established by comparing it with an accepted score of end-stage liver disease in children (12) and by the study of Huang et al. in the present issue (2). The studies showing the favorable prognostic accuracy of the MEGX test have been performed on a limited number of patients. Thus, Oellerich et al. repeatedly report on their prospective study (9-11) and it is difficult to assess the number studied since the numbers diverge. The two most recent publications of these authors reported to have performed the test on 101 patients 28 of whom died (10) and on 164 patients 26 of whom died (11); Huang et al. add 71 patients (9 died" @default.
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• W2014932366 title "MEGX test in hepatology: The long-sought ultimate quantitative liver function test?" @default.
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• W2014932366 doi "https://doi.org/10.1016/s0168-8278(05)80169-2" @default.
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