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Our study investigates liver involvement serum parameters in 71 subjects with cholelithiasis and choledocholithiasis, without primary liver diseases. As a control group 118 healthy subjects were studied. All patients have been examined for serum transaminases, alkaline phosphatase and gamma-glutamyl-transpeptidase, total bilirubin and for liver enlargement. The results point out the presence of increased alkaline phosphatase and gamma-glutamyl-transpeptidase levels in more than half examined patients, and in nearly half of those without hyperbilirubinemia. This fact confirms that the existence of biliary lithiasis itself (even if limited to gall-bladder, in absence of jaundice) may account for the occurrence of a subclinical cholestatic liver impairment, that should be carefully considered in long-term prognosis of these patients.

Successive clinical and laboratory data of 73 cirrhotics, who died during a follow-up period, were evaluated. The relationships between the actual survival time and 22 potentially prognostic variables were studied by means of the log-rank test and the likelihood ratio test. Seven variables (presence of ascites, hepatic encephalopathy and oesophageal varices; serum albumin, total bilirubin, gamma-globulin percentage and cholesterol) showed a strict correlation with survival time, and were included in a multiple regression model in order to compute the specific "prognostic weight" of each parameter. Results show that the parameters directly related to liver cell biosynthesis or indicating a structural liver damage should be considered more reliable for predicting theoretical survival in patients with liver cirrhosis.

The aim of this paper is to evaluate the relationships among the increase of serum bile acids (SBA) and other common liver function tests in subjects with liver cirrhosis. Our results show that SBA levels are well-correlated with the seriousness of the disease (classified according to Child's criteria), and with the presence of ascites, of oesophageal varices, of hepatic encephalopathy and with the gamma-globulin level. SBA also appear to be well-correlated with total bilirubinemia, and, at a lower extent, with cholesterolemia and albuminemia; no significant linear correlation was found among SBA and cholestasis (alkaline phosphatase, gamma-glutamyl-transpeptidase) or cytolysis (transaminases) indexes. In conclusion, the SBA increase in liver cirrhosis without evidence of cholestasis (as in our patients) seems to be related to liver cell reuptake disturbances and to the presence of porto-systemic shunts, with consequent alterations in entero-hepatic bile salt recirculation.

In a group of followed-up liver cirrhotics we evaluated the reliability of prognostic estimates predicted on the basis of a previously described multivariate statistical model (MSM). In the same subjects we also compared theoretical survival estimates obtained by fitting some other liver cirrhosis grading scores (Child-Turcotte's, McCormick's and Orrego's) to prognostic purposes. No statistical difference between actual and MSM-estimated survivorship functions was found (employing a life-table method with Logrank test), thus confirming the prognostic reliability of this multivariate classification model. Such a global and prognosis-correlated index may be recommendable both for comparing different groups of patients, and for assessing treatment effectiveness. Or results also substantially confirm the other investigated classificative methods such as reliable liver cirrhosis severity indexes, although their use for prognostic purposes seems to be less suitable.