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Thrombin Generation in Acute and Chronic Liver Disease in Children

Giovina Di Felice1, Anna Lisa Montemari1, Andrea Pietrobattista2

  • 1Clinical Laboratory Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy.

Diagnostics (Basel, Switzerland)
|May 13, 2026
PubMed

Insights

Prothrombin time (PT-INR) does not fully assess coagulation in pediatric liver disease. Thrombin generation assay (TGA) offers a more complete picture of hemostasis, providing valuable complementary information beyond standard tests.

Area of Science:

  • Pediatric Hematology
  • Hepatology
  • Coagulation Science

Background:

  • Pediatric liver disease often presents with abnormal coagulation tests.
  • Prothrombin time (PT-INR) offers an incomplete assessment of global hemostatic balance.
  • Thrombin generation assay (TGA) may provide complementary insights in acute liver failure (ALF) and chronic liver disease (CLD).

Purpose of the Study:

  • To compare thrombin generation assay (TGA) with conventional coagulation tests in pediatric liver disease.
  • To assess the utility of TGA in reflecting global hemostatic balance in children with ALF and CLD.
  • To explore correlations between PT-INR and TGA parameters.

Main Methods:

  • Enrolled 61 pediatric patients with liver disease and 51 healthy controls.
  • Measured thrombin generation using ST Genesia (STG) with normalization to reference plasma.
  • Utilized non-parametric tests, correlation analysis, and principal component analysis (PCA).

Main Results:

  • PT-INR was significantly elevated in patients, especially with ALF.
  • Patients exhibited reduced fibrinogen, procoagulant/anticoagulant factors, and increased factor VIII.
  • Correlations between PT-INR and TGA parameters were weak; PCA indicated TGA provides complementary information.

Conclusions:

  • Conventional PT-INR does not reliably reflect global coagulation in pediatric liver disease.
  • Thrombin generation testing offers integrative hemostatic information.
  • TGA may enhance laboratory assessment beyond conventional coagulation tests.

Keywords:
acute liver diseaseschronic liver diseasecoagulationpediatricsthrombin generation

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