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Endogenous thrombin potential and examination of a further 31 analytes in liver transplant candidates
F Kovacs1, Zs Gerlei2, D Gorog2
1Kanizsai Dorottya Hospital, Central Laboratory, Nagykanizsa, Hungary.
Insights
Lactate dehydrogenase (LDH) and anti-thrombin III (ATIII) show promise for assessing clinical status in cirrhosis patients, potentially improving liver transplant patient classification. Conventional coagulation tests did not offer additional insights.
Area of Science:
- Hepatology
- Coagulation Science
- Transplant Medicine
Background:
- Cirrhosis significantly impacts patient status and disease differentiation.
- Endogenous thrombin potential (ETP) and coagulation variables are crucial in liver transplant-listed patients.
Purpose of the Study:
- To predict changes in patient status and differentiate liver diseases.
- To evaluate the utility of ETP and clinical chemistry in cirrhotic patients.
Main Methods:
- Compared ETP and analytes in cirrhotic patients versus controls using logistic regression.
- Analyzed analyte-ETP relationships with Spearman correlation.
- Utilized factor and discriminant analyses for cirrhosis etiologies.
- Applied logistic regression and survival analysis for status prediction.
Main Results:
- Cirrhotic patients showed higher INR/aPTT and lower AUC values compared to healthy subjects.
- Lactate dehydrogenase (LDH) and anti-thrombin III (ATIII) effectively predicted changes in patient status.
- Eighty percent of patients with low ATIII and high LDH experienced clinical deterioration.
Conclusions:
- ETP parameters offered no additional information beyond conventional coagulation tests in cirrhosis.
- LDH and ATIII are promising biomarkers for assessing clinical status in cirrhosis.
- These analytes can potentially enhance the classification system for liver transplant-listed patients.
Background:
To predict the change in patient status and differentation of the basic diseases, endogenous thrombin potential (ETP), clinical chemistry, and coagulation variables were measured in liver transplant-listed patients with different etiologies.
Methods:
Differences in values of ETP and analytes of 30 control persons and 164 cirrhotic patients were examined by means of binary logistic regression. The relationship between the analytes and ETP parameters were analyzed by means of Spearman correlation. The different etiologies of cirrhosises were studied by factor and discriminant analyses. Binary logistic regression was applied to forecast changes in clinical status. Survival analysis was carried out with the appropriate variable.
Results:
International Normalized Ratio and activated partial thromboplastin time values were higher, whereas the area-under-the-curve values were lower in cirrhosis than in healthy subjects. A strong relationship was found only between the peak height and the anti-thrombin III (ATIII) values. In the factor analysis, 3 factors were found, which explained 81.6% of the total variance. Combination of aspartate aminotransferase and ATIII mostly separated the basic disease groups from each other in the discriminant analysis. From 35 variables, the lactate dehydrogenase (LDH) and ATIII have been suited for predicting the change in patient status. Eighty percent of patients with low ATIII and high LDH levels had deterioration of their clinical status.
Conclusions:
Our study demonstrated that the ETP parameters did not provide additional information compared with "conventional" coagulation tests in cirrhosis. On the basis of our study, LDH and ATIII appear to be promising analytes to assess the clinical status of patients with cirrhosis. In our opinion, the classification system of liver transplant-listed patients can be improved with their use.
