DOI: https://doi.org/10.53350/pjmhs22168605 ORIGINAL ARTICLE P J M H S Vol. 16, No. 08, August 2022 605 Evaluation of Liver Function Among Patients Presented with Hepatocellular Carcinoma SHABANA LAKHO 1 , DOLAT SINGH 2 , ZAHEER HUSSAIN MEMON 3 , SAJAN SAWAI 4 , NAND LAL SEERANI 5 , HIRA LAGHARI 6 1 Assistant professor of Gastroenterology, CMCH Larkana 2 Assistant professor of medicine, Indus Medical College TM Kahn 3 Assosiate Professor of Medicine, Indus Medical College TM Kahn 4 Assistant professor of Gastroenterology, Indus Medical College TM Kahn 5 Assistant professor of Gastroenterology, Liaquat university Hospital Hyderabad 6 Registrar of gastroenterology department, LUMHS/ Jamshoro Corresponding author: Sajan sawai, Email: drsaajansawai@gmail.com ABSTRACT Objective: To determine the liver function assessment in the patients presented with hepatocellular carcinoma. Methodology: This cross-sectional study was done at the gastroenterology departments of Liaquat University Hospital Hyderabad and Indus Medical College TM Khan. Patients with an age range of 20 to 70 years, both genders, and having hepatocellular carcinoma were included in the study. A 5 mL blood sample was taken from each participant and sent to the hospital diagnostic laboratory to assess the serum bilirubin level and albumin level. The albumin-bilirubin (ALBI) score was used for hepatic function. Data was collected using a self-made research proforma, and it was analyzed using SPSS 26. Results: A total of 58 cases having HCC were assessed regarding hepatic function. The mean age of the patients was 55.39+12.39 years. Males were in the majority 75.9%, and females were 24.1%. The majority of the patients (72.4%) had child Pugh class C, 12.1% had child Pugh class B, and 15.5% of the cases had child Pugh class A. Elevated bilirubin levels of albumin levels and Alpha-fetoprotein levels were significantly associated to the child Pugh class C (p= <0.05). Most of the cases, 67.3%, had an ALBI score > − 1.39, 10.3% cases had ALBI score − 2.59 to − 1.39, and 22.4% of patients had an ALBI score ≤ − 2.60. Conclusion: Severe hepatic dysfunction was observed to be frequently high among patients having hepatocellular carcinoma, as most of the cases had Pugh class C and ALBI stage 3. Due to the extremely small sample size used in this study, the results are not trustworthy. Keywords: HCC, Hepatic function, Bilirubin, Albumin, ALBI INTRODUCTION Hepatocellular carcinoma is a serious health issue and the fourth most common cause of carcinoma-related death throughout the world. 1 Its overall rate of survival is very poor. Only 2% of patients with metastatic hepatic cancer have a 18.4% five-year proportional rate of survival. 1 HCC is frequently caused by cirrhosis, which can be brought on by nonalcoholic steatohepatitis, alcoholism, hepatitis B, or hepatitis C, though its etiology differs globally. 2,3 An important phase in the viral carcinogenesis of hepatic cancer in patients with cirrhosis. The major pathophysiology for oncogenesis in hepatitis B virus is the integration of its viral genome into the host genome. 4 60% of occurrences of HCC are caused by viral genome insertions in the human genome’s telomerase reverse transcriptase (TERT) promoter regions. 4,5 Baseline liver function evaluations upon diagnosis may be able to predict prognosis in individuals with HCC because many of them have advanced liver disease or cirrhosis and reduced liver function. 2 In patients suffering from HCC, baseline liver function influences the patient's survival, and various liver function parameters have now been implicated as potential predictors of poor prognosis. Based on a complex interaction of characteristics, such as tumor size, quantity, localization, and clinical manifestations, such as baseline liver function, the best treatment approach for HCC is chosen. 6 It is challenging to assess the liver's function in a thorough manner due to its numerous and intricate tasks. The severity of the hepatic damage helps to determine whether hepatectomy is necessary and how much of the liver can be resection, but it has no bearing on the use of nonsurgical treatments. 6 From serum bilirubin concentration to indocyanine green clearances, single assays can provide useful but restricted findings. 7 The latest model for determining the severity of hepatic disease is the albumin-bilirubin (ALBI) score, which combines the blood albumin and bilirubin levels. 8,9 It has recently been shown that in individuals having hepatic cancer, the ALBI score more reliably identifies patients' deaths without necessitating subjective indicators of hepatic failure, such as ascites and encephalopathy. 8,9 The current study has been done to determine the liver function assessment in the patients presented with hepatocellular carcinoma. MATERIAL AND METHODS This was a cross-sectional study and was done at the gastroenterology department of Liaquat University Hospital, Hyderabad and Indus Medical College T. M. Khan. The study duration was one year from April 2018 to March 2019. Patients with an age range of 20 to 70 years, both genders, and having hepatocellular carcinoma were included in the study. Patients having other carcinoma and those who did not agree to participate in the study were excluded. Verbal informed consent was taken in all the cases. After taking medical history and complete clinical assessment, a ml blood sample was taken from each participant and was sent to the hospital diagnostic laboratory to assess the liver function test (LFT). Hepatic cirrhosis severity was taken as per the child Pugh classification. The albumin-bilirubin (ALBI) score was used for hepatic function. 8,9 The ALBI score was determined by the following formula: (log10 bilirubin × 0.66) + (albumin × − 0.085). The ALBI score was graded as: score ≤− 2.60 as ALBI-1; − 2.59 to − 1.39 as ALBI-2; and score > − 1.39 as ALBI- 3. Data was collected using a self-made research proforma, and it was analyzed using SPSS 26. T- test was used, and a p-value of <0.05 was taken as significant. RESULTS A total of 58 cases having HCC were assessed regarding hepatic function. The mean age of the patients was 55.39+12.39 years, avenge duration of CLD was 06.52+3.06 years and the average of HCC duration was 2.24+0.75 years. Males were in the majority 75.9%, and females were 24.1%. Out of all, 34.5% of the cases had comorbidities, and 63.8% of the patients had history of ascites. The majority of the patients (72.4%) had child Pugh class C, 12.1% had child Pugh class B, and 15.5% of the cases had child Pugh class A. Table.1 Table 2 shows that elevated bilirubin levels, albumin levels, and Alpha-fetoprotein levels were significantly associated with the child Pugh class C (p = 0.05). According to ALBI score, most of the cases (67.3%) had a score > − 1.39, 10.3% cases had an ALBI score − 2.59 to − 1.39 and 22.4% patients had ALBI score ≤ − 2.60. Table.3