617 Free Serum Cortisol Levels as a Predictive Factor for Survival in Patients With Liver Cirrhosis and Acute Variceal Bleeding

Triantos, C.; Kalafateli, Maria; Samonakis, D.; Zisimopoulos, Konstantinos; Papiamonis, N; Sapountzis, Apostolos; Michalaki, Marina; Theocharis, Georgios; Thomopoulos, Konstantinos; Labropoulou-Karatza, Chryssoula; Kiriazopoulou, V.; Jelastopulu, Eleni; Nikolopoulou, V.; Burroughs, A.K.

doi:10.1016/s0168-8278(13)60619-4

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“…Experimental studies on hepatoma cells have shown that heparin inhibits cellular invasion [28], whereas clinical studies have described a positive e ect of LMWHs on cancer survival [29]. Considering that raised anti Xa levels were predictive for 6-week mortality and that approximately 57% of variceal bleeders with raised anti Xa levels had HCC, this might re ect the con rmed strong association between HCC and bleeding-related mortality in portal hypertensive bleeding [30,31]. Patients with HCC have higher hepatic venous pressure gradient (HVPG) compared to patients without HCC [32] and HVPG is a known predictive factor of mortality in patients with variceal bleeding [30].…”

Section: Discussionmentioning

confidence: 99%

Endogenous Heparinoids Detected by anti-Xa Activity are Present in Blood during Acute Variceal Bleeding in Cirrhosis. A Prospective Study

Triantos

Louvros

Kalafateli

et al. 2014

JGLD

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Background & Aims: Endogenous heparinoids have been detected by thromboelastography and quantified by clotting based anti-Xa activity assays in patients with cirrhosis, but their presence in variceal bleeding has not been established yet.Methods: Clotting based anti-Xa activity was measured in A) 30 cirrhotics with variceal bleeding, B) 15 noncirrhotics with peptic ulcer bleeding, C) 10 cirrhotics without infection or bleeding, and D) 10 cirrhotics with hepatocellular carcinoma (HCC).Results: Anti-Xa activity was not detected in ulcer bleeders or in cirrhotics without infection or bleedingbut was present in seven (23%) variceal bleeders (median levels: 0.03 u/mL (0.01-0.07)) and was quantifiable for 3 days in six of seven patients. Four of seven variceal bleeders with anti-Xa activity present had HCC (p=0.023). Age, creatinine, platelet count and total infections the second day from admission were significantly correlated with the presence of measureable anti-Xa levels (p=0.014, 0.032, 0.004 and 0.019, respectively). In the HCC group, anti-Xa activity was present in three patients (30%) [median levels: 0.05 u/mL (0.01-0.06)].Conclusions: In this study, variceal bleeders and 30% of the patients with HCC had endogenous heparinoids that were detected by a clotting based anti-Xa activity assay, whereas there was no anti Xa activity present in patients with cirrhosis without infection, or bleeding or HCC, nor in those with ulcer bleeding. Thus, the anti-Xa activity is likely to be a response to bacterial infection and/or presence of HCC in cirrhosis.List of abbreviations: AFP, alpha-fetoprotein; aPTT, activated partial thromboplastin time; CP, Child-Pugh; FXa, activated factor X; GAGS, glycosaminoglycans; Hb, hemoglobin; HCC, hepatocellular carcinoma; HVPG, hepatic venous pressure gradient; INR, International normalized ratio; LMWHs, low molecular weight heparins; MELD, Model for End-stage Liver Disease; PPP, platelet-poor plasma; PRBC, packed red blood cells; PT, prothrombin time; SBP, sponataneous bacterial peritonitis; TEG, thromboelastography; WBC, white blood cells.

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