Alterations in Primary Haemostasis in Patients With Liver Cirrhosis and Bacterial Infection

There is a controversy regarding hyporesponsiveness of platelet (PLT) aggregation in liver cirrhosis (LC). This study aimed to assess alterations in PLT aggregation and von Willebrand factor (vWF)-related parameters, as well as their prognostic role in bacterial infection (BI) superimposed on LC.

PLT aggregation was assessed using thromboelastography PLT mapping assay. vWF antigen (vWF:Ag), vWF Ristocetin cofactor (vWF:RCo) and FVIII levels were also measured in patients with decompensated cirrhosis and BI (DC + BI), stable decompensated cirrhosis (SDC) and infection without LC (control group). The prognostic value of PLT aggregation was evaluated only in the DC + BI group.

Seventy-one patients were enrolled in the DC + BI, 38 in the SDC and 20 in the control group. Patients with DC + BI had significantly reduced PLT aggregation in response to adenosine diphosphate (ADP) compared with those with SDC (p = 0.042). Elevated vWF:Ag, vWF:RCo and FVIII levels accompanied impaired PLT aggregation_(ADP) (p = 0.002, p = 0.003 and p = 0.042, respectively). Within the DC + BI group, patients with organ failure exhibited lower PLT aggregation_(ADP). In survival analysis of the DC + BI group, non-survivors demonstrated reduced ADP-induced PLT aggregation, which showed high accuracy in predicting mortality (AUROC = 0.851). In a multivariate cox regression model including age, gender, MELD score and PLT aggregation_(ADP), age (p = 0.048), gender (p = 0.023) and PLT aggregation_(ADP) (p < 0.001) were independently associated with 30-day mortality.

ADP-induced PLT aggregation is impaired in DC with infection in a stepwise manner according to infection severity and has prognostic implications, as it is associated with 30-day mortality. Elevated vWF:Ag, vWF:RCo and FVIII levels accompany PLT hyporesponsiveness.