Low serum factor V level: early predictor of allograft failure and death following liver transplantation

Zulian, Maurício Cardoso; Chedid, Marcio; Chedid, Aljamir Duarte; Filho, Tomaz J. M. Grezzana; Leipnitz, Ian; Araújo, Alexandre de; Álvares‐da‐Silva, Mário Reis; Cardoni, Mario Gurvitez; Guimarães, Luciano Santos Pinto; Kruel, Cléber Dario Pinto

doi:10.1007/s00423-015-1290-2

Cited by 17 publications

(13 citation statements)

References 19 publications

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“…Factor V has been more extensively studied in non-trauma situations, including liver transplantation and shock. Zulian et al found factor V serves as an early predictor of allograft failure and death in liver transplant patients(21). Additionally, the PROWESS trial found heterozygous factor V leiden carriers displayed reduced mortality in the setting of sepsis(22).…”

Section: Discussionmentioning

confidence: 99%

Individual clotting factor contributions to mortality following trauma

Kunitake

Howard

Kornblith

et al. 2017

Journal of Trauma and Acute Care Surgery

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BACKGROUND Acute traumatic coagulopathy (ATC) afflicts 20–30% of trauma patients, but the extensive collinearity of the coagulation cascade complicates attempts to clarify global clotting factor dysfunction. This study aims to characterize phenotypes of clotting factor dysfunction and their contributions to mortality after major trauma. METHODS This prospective cohort study examines all adult trauma patients of the highest activation level presenting to San Francisco General Hospital between 2/2005 and 2/2015. Factors II, V, VII, VIII, IX, X, and protein C activity on admission and mortality status at 28 days were assessed. Predictors of 28-day mortality in univariate analysis were included in multiple logistic regression controlling for traumatic brain injury (TBI), acidosis, age, and mechanism of injury. Principal component analysis (PCA) was utilized to identify phenotypic coagulation. RESULTS Complete coagulation factor data was available for 876/1,429 (61%). In multiple logistic regression, factors V (OR: 0.86, CI95%: 0.76–0.97), VIII (OR: 0.97, CI95%: 0.95–0.99), X (OR: 0.79, CI95%: 0.68–0.92), and protein C (OR: 1.17, CI95%: 1.05–1.30) significantly predicted 28-day mortality after controlling for age, base deficit, mechanism of injury, and TBI. PCA identified 2 significant principal components (Phenotypes 1 and 2) that accounted for 66.3% of the total variance. Phenotype 1 (factors II, VII, IX, X, and protein C abnormalities) explained 49.3% and was associated with increased injury, coagulopathy, TBI, and mortality. Phenotype 2 (factors V and VIII abnormalities) explained 17.0% and was associated with increased coagulopathy, blunt injury, and mortality. Only Phenotype 2 remained significantly associated with 28-day mortality in multiple logistic regression. CONCLUSIONS PCA identified 2 distinct phenotypes within the entirety of global clotting factor abnormalities, and these findings substantiate the crucial association of factors V and VIII on mortality following trauma. This may be the first step toward identifying unique phenotypes after injury and personalizing hemostatic resuscitation. LEVEL OF EVIDENCE Prognostic study, Level III

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Section: Discussionmentioning

confidence: 99%

Individual clotting factor contributions to mortality following trauma

Kunitake

Howard

Kornblith

et al. 2017

Journal of Trauma and Acute Care Surgery

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“…Low coagulation factor synthesis and coagulopathy represent the earliest signs of liver dysfunction. Low levels of factor V seem to be early predictors (day 2) of allograft failure [8]. ROTEM assay, as a viscoelastic test, may represent a superior method of detection decreased coagulation kinetics.…”

Section: Discussionmentioning

confidence: 99%

“…Coagulation disorders represent one of the most early and specific signs for initial graft poor function (IGPF) [8,9]. Based on this assumption, the aim of our study was to evaluate if coagulation kinetics, as assessed by rotational thormoboelastometry (ROTEM) 24 hours after LT, can be used in the early diagnosis of EAD.…”

Section: Introductionmentioning

confidence: 99%

Rotational thromboelastometry (ROTEM) 24 hours post liver transplantation predicts early allograft dysfunction

Tomescu

Popescu

Dima

2018

Rom J Anaesth Int Care

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Early allograft dysfunction (EAD) represents one of the most common and serious complications after liver transplantation (LT). Methods. One hundred sixty-four patients who underwent LT were prospectively included in the present study. Patient demographics, intraoperative blood loss and transfusion were recorded at the time of LT. Lactate levels were recorded during surgery and daily for the first 3 postoperative days. Standard and derived rotational thromboelastometry (ROTEM) parameters were recorded 24 hours after LT. EAD was diagnosed according to Nanashima criteria and post anaesthesia care unit length of stay was recorded. Results. Forty-seven patients (28.6%) developed EAD. Intraoperative blood loss (p = 0.01), packed red blood cells (p = 0.04) and fresh frozen plasma (p = 0.01) transfusion represented intraoperative risk factors for EAD. Lactate levels were significantly higher in patients with EAD at all time points. Patients with EAD demonstrated an increased clot formation time and decreased maximum clot firmness in both intrinsically (p < 0.01) and extrinsically (p < 0.01) activated assay, a decreased thrombin potential index (p < 0.01), area under the curve (p < 0.01) and clot elasticity (p < 0.01) on ROTEM assay. Conclusion. Our results show that both standard and derived ROTEM parameters may indicate early signs of graft failure and can aid in the diagnosis of EAD.

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“…This may be the basis for the fact that the plasma half-life of factor V is relatively short, about 12-24 hours, and a decrease in factor V is the most sensitive indicator of liver failure [14,15]. Many studies also suggest that factor V levels are related to survival and can serve as a prognostic indicator [16][17][18]. Interestingly, the gene for factor V related to the family of multi-copper oxidases, and is homologous to coagulation factor VIII.…”

Section: Discussionmentioning

confidence: 99%

Bleeding complications associated with the molecular adsorbent recirculating system: a retrospective study

Yoo¹,

Ki²,

Kim³

et al. 2021

Acute Crit Care

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Background: The molecular adsorbent recirculating system (MARS) is a hepatic replacement system that supports excretory liver function in patients with liver failure. However, since MARS has been employed in our hospital, bleeding complications have occurred in many patients during or after MARS. The objective of this study was to determine how MARS affects coagulopathy and identify specific factors associated with bleeding complications.Methods: We retrospectively analyzed data from 17 patients undergoing a total of 41 MARS sessions. Complete blood count, coagulation profiles, and blood chemistry values were compared before and after MARS. To identify pre-MARS factors associated with increased bleeding after MARS, we divided patients into bleeder and non-bleeder groups and compared their pre-MARS laboratory values.Results: MARS significantly reduced bilirubin and creatinine levels. MARS also increased prothrombin time and reduced platelet and fibrinogen, thus negatively impacting coagulation. Pre-MARS hemoglobin was significantly lower in the bleeder group than in the non-bleeder group (P=0.015). When comparing the upper and lower 33% of MARS sessions based on the hemoglobin reduction rate, hemoglobin reduction was significantly greater in MARS sessions involving patients with low pre-MARS international normalized ratio of prothrombin time (PT-INR) and factor V (P=0.038 and P=0.023, respectively).Conclusions: MARS could appears to alter coagulation-related factors such as factor V and increase the risk of bleeding complications particularly in patient with low hemoglobin. However, individual differences among patients were large, and various factors, such as low hemoglobin, PT-INR, and factor V levels, appear to be involved.

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Low serum factor V level: early predictor of allograft failure and death following liver transplantation

Abstract: Assessment of serum factor V levels on postoperative day 2 might be a promising prognostic tool for early prediction of inferior outcomes after liver transplantation.

Cited by 17 publications

References 19 publications

Individual clotting factor contributions to mortality following trauma

Individual clotting factor contributions to mortality following trauma

Rotational thromboelastometry (ROTEM) 24 hours post liver transplantation predicts early allograft dysfunction

Bleeding complications associated with the molecular adsorbent recirculating system: a retrospective study

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