Quantitative Estimation of Coagulation Factors in Liver Disease. The Diagnostic and Prognostic Value of Factor XIII, Factor V and Plasminogen

Abstract

Summary20 coagulation parameters were investigated in 144 patients with different liver diseases. The groups of acute hepatitis, chronic active hepatitis and liver cirrhosis were compared and the prognostic value of the coagulation analyses investigated. It is clear that the determination of the factor V activity is a good and easy test for detection of actual liver function. Repeated controls over several weeks revealed with a statistical significance (p <0.0005) that all patients with a factor XIII below 35& and a plasminogen below 19& will die in liver coma, if they have not died beforehand from acute gastrointestinal haemorrhage, acute infection or cardiac arrest.Plasminogen is also lower in the group of non-survivors but the values of the two groups are overlapping and of no prognostic help in a single case. The possible causes of the diminution of factor XIII activity are discussed.

Correlation between Hepatic Blood Flow and Coagulation Indices in Chronic Active Hepatitis and Liver Cirrhosis Patients

“…The results of this investigation agree with a previous report showing low Normotest, Prekk, AT III, plasminogen and a 2-antiplasmin values in patients with chronic liver dis ease [8,[12][13][14]. With regard to the relation ship between these blood coagulation param eters and HBF, our study only partially agrees with the investigation of Fujii et al [5] which showed a good correlation between HBF, Normotest, and serum albumin in pa tients with chronic liver disease.…”

Prekallikrein Behaviour in Chronic Active Hepatitis and in Cirrhotic Patients

“…In fact, low plasma levels of these proteins have been reported in chronic liver disease and considered as a consequence of the impaired hepatic synthesis [2][3][4][5]. The evaluation of these proteins in chronic liver disease shows that plasma levels of ATIII, Prekk and plas minogen seem to be a good index of liver function [2,4,5].…”

“…The evaluation of these proteins in chronic liver disease shows that plasma levels of ATIII, Prekk and plas minogen seem to be a good index of liver function [2,4,5]. But the impaired hepatic synthesis could not be the only mechanism involved in such a condition; chronic liver disease, in fact, can be complicated by hyper fibrinolysis or chronic disseminated intra vascular coagulopathy (cDIC) and these two conditions could affect per se the plasma lev els of these proteins [6,7], However, these two last possibilities have not been taken into account in previous research [2,4,5], apart from the investigation of Annan et al [3].…”

Haemostasis Unbalance in Pugh-Scored Liver Cirrhosis: Characteristic Changes of Plasma Levels of Protein C versus Protein S

“…Severity o f liver cirrhosis is currently clas sified according to Child, as stages A , B and C , corresponding to mild, moderate and severe cirrhosis, respectively [1], and can be further divided into subclasses according to Pugh's modification [2,3], Several studies have investigated haemo stasis unbalance in these different stages, to assess both the diagnostic and the prognostic value o f coagulation parameters, in cirrhotic patients scored as Child A , B and C [4][5][6][7][8][9][10][11][12][13][14][15], Some reports indicate that coagulation inhibi tors are significantly reduced in liver cirrhosis in degrees roughly proportional to the impair ment o f liver synthesis function [16][17][18][19], However, in these studies the stage o f liver cirrhosis was not accurately defined (accord ing to Pugh score), nor were the correlation between levels o f protein C (PC) and its natu ral cofactor protein S (PS) investigated throughout the evolution o f the disease. The aim o f the present study was to evaluate the extent and the correlation in the change o f the main haemostatic parameters and, more spe cifically, o f the coagulation inhibitors P C , PS and antithrombin III (AT III), in the evolu tion o f the different stages o f liver cirrhosis scored according to Pugh's modifications of Child's classification.…”