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ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 37 Issue 3
Mar.  2021
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Article Navigation >  Journal of Clinical Hepatology  > 2021  >  37(3): 560-564

Role of coagulation abnormalities in thrombosis in patients with hepatitis B virus-associated acute-on-chronic liver failure

DOI: 10.3969/j.issn.1001-5256.2021.03.012

  • ICU of Department of Infectious Diseases, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China

  • Received Date: 2020-09-09
  • Accepted Date: 2020-10-28
  • Published Date: 2021-03-20
    Abstract
  •   Objective  To investigate the role of coagulation function parameters and platelet indices in thrombotic events in patients with hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF).  Methods  A total of 56 patients with HBV-ACLF who were hospitalized in The First Affiliated Hospital of Soochow University from January 2015 to December 2019 were enrolled and divided into thrombotic complication (TC) group with 24 patients and non-thrombotic complication (NTC) group with 32 patients. A retrospective analysis was performed for their general clinical data on admission, and the patients were observed in terms of the changes in coagulation function, platelet count (PLT), and the platelet function-related index mean platelet volume (MPV) on days 1-7 after admission. The t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U rank sum test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups. A repeated measures analysis of variance was used to compare coagulation markers within and between groups at different time points.  Results  On admission, the TC group had a significantly younger age than the NTC group [31.5 (29.0-34.0) years vs 48.5 (36.0-50.7) years, Z=-2.637, P=0.008]. On the day of admission, there was no significant difference in MPV between the TC group and the NTC group (P > 0.05), while on days 2-7 after admission, there was a significant difference in MPV between the two groups (t=-2.696、-2.742、-2.894、-4.174、-3.945、-4.716, all P < 0.01). In the TC group, MPV reached the peak value on day 5 of admission, with a mean value of 13.90±1.12 fl, which was higher than the range of normal values. On admission, all patients had a mean prothrombin time (PT) of 28.8±7.2 s, a mean activated partial thromboplastin time (APTT) of 50.5±8.7 s, and a mean international normalized ratio (INR) of 2.6±0.7, which were higher than normal values; all patients had a mean fibrinogen (Fb) level of 1.16±0.3 g/L and a mean PLT of (107.7±26.5)×109/L, which were lower than normal values. There were no significant differences in PT, APTT, Fb, INR, and PLT between the TC group and the NTC group (all P > 0.05).  Conclusion  Coagulation disorder in patients with liver failure is more of a low-equilibrium state, which is complex and heterogeneous and requires individualized treatment. For patients with HBV-ACLF, the development of thrombotic events may be more associated with platelet function than PLT or conventional coagulation markers.

     

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    • References(20)
  • [1]
    Liver Failure and Artificial Liver Group, Chinese Society of Infectious Diseases, Chinese Medical Association; Severe Liver Disease and Artificial Liver Group, Chinese Society of Hepatology, Chinese Medical Association. Guideline for diagnosis and treatment of liver failure(2018)[J]. J Clin Hepatol, 2019, 35(1): 38-44. (in Chinese) DOI: 10.3969/j.issn.1001-5256.2019.01.007

    中华医学会感染病学分会肝衰竭与人工肝学组, 中华医学会肝病学分会重型肝病与人工肝学组. 肝衰竭诊治指南(2018年版)[J]. 临床肝胆病杂志, 2019, 35(1): 38-44. DOI: 10.3969/j.issn.1001-5256.2019.01.007
    [2]
    VIOLI F, BASILI S, RAPARELLI V, et al. Patients with liver cirrhosis suffer from primary haemostatic defects? Fact or fiction?[J]. J Hepatol, 2011, 55(6): 1415-1427. DOI: 10.1016/j.jhep.2011.06.008
    [3]
    DABBAGH O, OZA A, PRAKASH S, et al. Coagulopathy does not protect against venous thromboembolism in hospitalized patients with chronic liver disease[J]. Chest, 2010, 137(5): 1145-1149. DOI: 10.1378/chest.09-2177
    [4]
    AGARWAL B, WRIGHT G, GATT A, et al. Evaluation of coagulation abnormalities in acute liver failure[J]. J Hepatol, 2012, 57(4): 780-786. DOI: 10.1016/j.jhep.2012.06.020
    [5]
    WARRILLOW S, FISHER C, TIBBALLS H, et al. Coagulation abnormalities, bleeding, thrombosis, and management of patients with acute liver failure in Australia and New Zealand[J]. J Gastroenterol Hepatol, 2020, 35(5): 846-854. DOI: 10.1111/jgh.14876
    [6]
    HABIB M, ROBERTS LN, PATEL RK, et al. Evidence of rebalanced coagulation in acute liver injury and acute liver failure as measured by thrombin generation[J]. Liver Int, 2014, 34(5): 672-678. DOI: 10.1111/liv.12369
    [7]
    ALLISON MG, SHANHOLTZ CB, SACHDEVA A. Hematological issues in liver disease[J]. Crit Care Clin, 2016, 32(3): 385-396. DOI: 10.1016/j.ccc.2016.03.004
    [8]
    BLASI A. Coagulopathy in liver disease: Lack of an assessment tool[J]. World J Gastroenterol, 2015, 21(35): 10062-10071. DOI: 10.3748/wjg.v21.i35.10062
    [9]
    LYU BY, LI Q. Strategies in the evaluation of coagulation status in patients with liver failure[J]. J Clin Hepatol, 2020, 36(4): 928-931. (in Chinese) DOI: 10.3969/j.issn.1001-5256.2020.04.049

    吕滨月, 李谦. 肝衰竭患者的出凝血状态评估策略[J]. 临床肝胆病杂志, 2020, 36(4): 928-931. DOI: 10.3969/j.issn.1001-5256.2020.04.049
    [10]
    STRAVITZ RT, ELLERBE C, DURKALSKI V, et al. Bleeding complications in acute liver failure[J]. Hepatology, 2018, 67(5): 1931-1942. DOI: 10.1002/hep.29694
    [11]
    YIN JB, NIU Y, QIAN LY, et al. Mean platelet volume predicts survival in patients with hepatocellular carcinoma and type 2 diabetes[J]. Diabetes Res Clin Pract, 2019, 151: 120-127. DOI: 10.1016/j.diabres.2019.04.012
    [12]
    MADAN SA, JOHN F, Pitchumoni CS. Nonalcoholic fatty liver disease and mean platelet volume: A systemic review and Meta-analysis[J]. J Clin Gastroenterol, 2016, 50(1): 69-74. DOI: 10.1097/MCG.0000000000000340
    [13]
    POKORA RODAK A, KICIAK S, TOMASIEWICZ K. Neutrophil-lymphocyte ratio and mean platelet volume as predictive factors for liver fibrosis and steatosis in patients with chronic hepatitis B[J]. Ann Agric Environ Med, 2018, 25(4): 690-692. DOI: 10.26444/aaem/99583
    [14]
    KISACIK B, TUFAN A, KALYONCU U, et al. Mean platelet volume (MPV) as an inflammatory marker in ankylosing spondylitis and rheumatoid arthritis[J]. Joint Bone Spine, 2008, 75(3): 291-294. DOI: 10.1016/j.jbspin.2007.06.016
    [15]
    YATES KR, WELSH J, ECHRISH HH, et al. Pancreatic cancer cell and microparticle procoagulant surface characterization: Involvement of membrane-expressed tissue factor, phosphatidylserine and phosphatidylethanolamine[J]. Blood Coagul Fibrinolysis, 2011, 22(8): 680-687. DOI: 10.1097/MBC.0b013e32834ad7bc
    [16]
    EXNER T, JOSEPH JE, CONNOR D, et al. Increased procoagulant phospholipid activity in blood from patients with suspected acute coronary syndromes: A pilot study[J]. Blood Coagul Fibrinolysis, 2005, 16(5): 375-379. DOI: 10.1097/01.mbc.0000173465.45613.a3
    [17]
    BRAEKKAN SK, MATHIESEN EB, NJ lSTAD I, et al. Mean platelet volume is a risk factor for venous thromboembolism: The tromsø study, tromsø, norway[J]. J Thromb Haemost, 2010, 8(1): 157-62. DOI: 10.1111/j.1538-7836.2009.03498.x
    [18]
    LISMAN T, BONGERS TN, ADELMEIJER J, et al. Elevated levels of von Willebrand Factor in cirrhosis support platelet adhesion despite reduced functional capacity[J]. Hepatology, 2006, 44(1): 53-61. DOI: 10.1002/hep.21231
    [19]
    O'SHAUGHNESSY DF, ATTERBURY C, BOLTON MAGGS P, et al. Guidelines for the use of fresh-frozen plasma, cryoprecipitate and cryosupernatant[J]. Br J Haematol, 2004, 126(1): 11-28. DOI: 10.1111/j.1365-2141.2004.04972.x
    [20]
    SEGAL JB, DZIK WH, Transfusion Medicine/Hemostasis Clinical Trials Network. Paucity of studies to support that abnormal coagulation test results predict bleeding in the setting of invasive procedures: An evidence-based review[J]. Transfusion, 2005, 45(9): 1413-1425. DOI: 10.1111/j.1537-2995.2005.00546.x
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