Biochemical Liver Tests: Recent Developments and Challenges

Abstract

Concurrent with the explosive growth of clinical laboratory testing during the last 30 years, an enormous number of biochemical tests have been proposed for diagnosis and monitoring of hepatobiliary disorders. The wealth of candidate tests obviously reflect the myriad of functions performed by the liver. Their development has also been spurred by the intense interest of clinicians who are confronted daily with the question of whether a patient has a hepatobiliary disorder. Notwithstanding this enormous and continuing activity at the drawing boards in hepatological reseach and clinical biochemistry laboratories, almost no change has occurred in the armamentarium of biochemical liver tests routinely employed in clinical practice. Assays of total bilirubin and conjugated bilirubins in serum and bilirubins in urine have been used widely for clinical purposes since the second decade of this century. Measurement of alkaline phosphatase and transaminase activities in serum became widespread in the early 1950s. Together with the one-stage prothrombin time and some form of assessment of serum albumin and gamma-globulins, these analyses continue to be the only biochemical tests to enjoy general acclaim and are considered indispensable clinical tools in the follow-up of patients with suspected or established liver disease.