Related Experiment Video
Updated: Jan 9, 2026
Assessment of Plasma Coagulation on Liver Tissue in a Large Animal Model In Vivo
Published on: August 4, 2018
Coagulation abnormalities in children with chronic liver disease and the association of these abnormalities with
Rubaiyat Alam1, Mst Arifa Main1, Khan Lamia Nahid1
1Department of Pediatric Gastroenterology and Nutrition, Bangladesh Medical University, Dhaka 1000, Bangladesh.
Insights
In pediatric chronic liver disease (CLD), international normalized ratio (INR) and albumin levels reliably predict disease severity. The albumin-bilirubin (ALBI) score offers a more consistent assessment of liver function than the Child-Pugh score for risk stratification.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Hematology
Background:
- Chronic liver disease (CLD) in children presents complex challenges.
- Coagulation abnormalities are common in CLD and can impact patient outcomes.
- Understanding these abnormalities is crucial for effective disease management.
Purpose of the Study:
- To evaluate the coagulation profile in pediatric patients with CLD.
- To determine the relationship between coagulation status and CLD severity.
- To identify reliable predictors of disease progression in pediatric CLD.
Main Methods:
- Prospective study of 51 children with CLD, stratified by Child-Pugh class.
- Analysis of laboratory parameters including complete blood count, prothrombin time, activated partial thromboplastin time (APTT), international normalized ratio (INR), fibrinogen, D-dimer, and albumin-bilirubin (ALBI) score.
- Logistic regression used to identify independent predictors of Child-Pugh class.
Main Results:
- Autoimmune hepatitis and Wilson's disease were the most frequent causes of CLD.
- Clinical complications like ascites and encephalopathy were more prevalent in severe CLD (Child-Pugh C).
- INR, APTT, and D-dimer levels increased with disease severity, while albumin decreased. INR and hypoalbuminemia were strong independent predictors.
- The ALBI score correlated well with liver function markers and coagulation parameters.
Conclusions:
- International normalized ratio (INR) and serum albumin are key indicators of disease severity in pediatric CLD.
- The albumin-bilirubin (ALBI) score demonstrates superior reproducibility for assessing hepatic reserve compared to the Child-Pugh score.
- The ALBI score is a valuable tool for risk stratification in children with CLD.
Background And Aims:
This study aimed to evaluate the coagulation profile in children with chronic liver disease (CLD) and to investigate the relationship between coagulation abnormalities and disease severity.
Methods:
Fifty-one consecutive children (mean age 7.4 ± 4.9 years) diagnosed with CLD were prospectively included and stratified by the Child-Pugh class (A, B, C). Laboratory data, including the complete blood count, prothrombin time, activated partial thromboplastin time (APTT), international normalized ratio (INR), fibrinogen, D-dimer, and albumin-bilirubin (ALBI) score, were analyzed. Logistic regression identified predictors of the Child-Pugh class.
Results:
Autoimmune hepatitis (31.3%) and Wilson's disease (27.4%) were the most common etiologies. Clinical features, such as gastrointestinal bleeding, ascites, and encephalopathy, were more common in Child-Pugh class C (p = 0.002). The INR (p = 0.017), the APTT (p = 0.018), and D-dimer concentrations (p = 0.001) increased with disease severity, while albumin concentrations decreased. The INR (OR: 86.8 for B vs A; OR: 82.4 for C vs A, p = 0.004) and hypoalbuminemia (OR: 0.11 for C vs A, p = 0.004) were the most robust independent predictors. D-dimer concentrations predicted advanced disease but lost significance after adjustment. The ALBI score was correlated with albumin, the INR, prothrombin time, the APTT, and D-dimer, while Child-Pugh score correlations were weaker. Fibrinogen concentrations were reduced in 64.7% of patients but not associated with severity.
Conclusion:
The INR and albumin are reliable predictors of disease severity in pediatric CLD. The ALBI score provides more reproducible assessment of hepatic reserve than the Child-Pugh score and may be a useful tool for risk stratification in children.
Related Concept Videos
01:24Disorders of Hemostasis
Thromboembolic Disorders
Two factors primarily cause thromboembolic conditions.
01:26Effect of Hepatic Disease on Pharmacokinetics: Drug Dosing and Hepatic Blood Flow
01:22Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test
01:27Inflammatory Bowel Disease I: Ulcerative Colitis
Inflammatory bowel disease, or IBD, encompasses a group of disorders characterized by chronic inflammation or ulceration of the gastrointestinal tract.
Risk Factors
The exact cause of IBD remains unclear, although it is believed to be due to a mix of genetic, environmental, microbial, and immune factors. Genetic factors are significant in determining susceptibility to IBD, with family history being a critical risk factor. Individuals with a first-degree relative who has IBD are at...
01:26Diseases of the Liver and Gallbladder
Cirrhosis is characterized by the scarring of hepatic lobules in the liver, which are replaced by fibrous tissue, affecting the liver's normal functioning. NAFLD, on the other hand, is caused by an excessive build-up of fat in the liver, not...
01:28Esophageal Varices-II: Clinical Features and Management
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...