Clinical significance of the change in plasma D-dimer in patients with hepatitis B cirrhosis

Objective To investigate the correlation between plasma D-dimer level and severity of hepatitis B cirrhosis and its value in the diagnosis of portal vein thrombosis( PVT). Methods A retrospective analysis was performed for the clinical data of 500 patients with hepatitis B cirrhosis who were hospitalized in The Fifth Medical Center of Chinese PLA General Hospital from January to December,2018,and according to the plasma level of D-dimer,they were divided into normal group with 217 patients and elevated group with 283 patients. The correlations of plasma D-dimer level with Child-Pugh class and Model for End-Stage Liver Disease( MELD) score were compared between the two groups. The t-test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the Kruskal-Wallis H test was used for multiple groups comparison and further pairwise comparison. The chi-square test was used for comparison of categorical data between two groups. A Spearman correlation analysis was used to investigate correlation. The receiver operating characteristic( ROC) curve was used to evaluate the early warning performance of D-dimer level for PVT in patients with hepatitis B cirrhosis. Results There were significant differences between the two groups in D-dimer level,alanine aminotransferase,aspartate aminotransferase,total bilirubin,albumin,Child-Pugh class,MELD score,and incidence rate of PVT( all P < 0. 05). The correlation analysis showed that plasma D-dimer level was positively correlated with Child-Pugh class and MELD score in both groups( r = 0. 463,0. 455,0. 214,and 0. 756,all P <0. 05). A total of 50 patients with hepatitis B cirrhosis were found to have PVT; the patients with PVT had a significantly higher D-dimer level that those without PVT [1. 96( 0. 82-4. 91) mg/L vs 0. 61( 0. 19-1. 54) mg/L,Z =-6. 02,P < 0. 001]. The ROC curve analysis showed that D-dimer level had an area under the ROC curve of 0. 758( 95% confidence interval: 0. 719-0. 796) at the optimal cut-off value of 0. 76 mg/L. Conclusion Plasma D-dimer level is correlated with the severity of hepatitis B cirrhosis and can be used to predict the prognosis of patients with hepatitis B cirrhosis. The possibility of PVT should be considered in patients with an elevated D-dimer level.