High-D-dimer plasma levels predict poor outcome in esophageal variceal bleeding

Area of Science:

• Hepatology
• Hemostasis Research
• Critical Care Medicine

Background:

• Variceal bleeding in liver cirrhosis patients has a high mortality rate.
• Hemostasis system abnormalities, including coagulation and fibrinolysis, are common in these patients.

Purpose of the Study:

• To investigate if hemostasis system abnormalities are independently related to mortality in cirrhotic patients with variceal bleeding.
• To identify independent predictors of death in this patient population.

Main Methods:

• Assessed global coagulation, coagulation activation, and fibrinolysis in 43 bleeding cirrhotic patients and 43 non-bleeding cirrhotic controls.
• Performed baseline and follow-up measurements in bleeders, and baseline only in non-bleeders.

Main Results:

• Coagulation activation and fibrinolysis were more impaired in bleeding patients.
• Persistently abnormal prothrombin time, tissue plasminogen activator antigen, and D-dimer levels were observed in patients who died.
• Univariate analysis identified high D-dimer, infection, Child-Pugh C, and MELD score >= 17 as predictors of death.

Conclusions:

• High D-dimer and infection are independent predictors of mortality in cirrhotic patients with variceal bleeding.
• High D-dimer is a stronger predictor than Child-Pugh C class but not MELD score >= 17.