Abstract
BackgroundAcute-on-chronic liver failure (ACLF) is a syndrome characterized by profound disrupted coagulation and fibrinolysis. Fibrinolytic marker D-dimer is increased in critically ill patients with cirrhosis which is associated with poorer prognosis. We aim to determine the potential association of D-dimer with the 28-day mortality in ACLF patients.MethodsIn a single center retrospective study performed in China, we collected data of 115 patients with ACLF from October 1, 2012 to December 31, 2016. We investigated correlations between D-dimer and other laboratory tests and prognostic scores. The relationship between D-dimer and 28-day mortality was explored by smoothing plot with an adjustment for potential confounders. Logistic regression analyses with crude and adjusted models were performed to explore the association of D-dimer with 28-day mortality in ACLF patients.ResultsIn ACLF patients, D-dimer at admission was correlated with all prognostic scores (MELD-Na: r = 0.385, P < 0.001; CLIF-C ADs: r = 0.443, P < 0.001; CLIF-C ACLFs: r = 0.375, P < 0.001). A nonlinear relation between D-dimer and 28-day mortality was found with a turning point at 6.5 mg/L FEU. D-dimer level was independently associated with 28-day mortality with an adjusted odds ratio of [1.4 (1.0–1.9), P = 0.030] as continuous variable and [10.3 (1.3, 81.5), P = 0.028] as a classified variable with the cut-off of 6.5 mg/L FEU. An elevated D-dimer within the following 10 days also tended to be associated with higher risk of 28-day mortality [OR: 27.5 (0.9, 814.9), P = 0.055].ConclusionsElevated D-dimer levels was associated with increased risk of 28-day mortality in patients with ACLF in China.
Highlights
Acute-on-chronic liver failure (ACLF) is a syndrome characterized by profound disrupted coagulation and fibrinolysis
94.5% of the subjects had Hepatitis B virus (HBV) related chronic liver disease, 54.8% were diagnosed with cirrhosis, 94.8% were combined with clinical ascites, and 27.0% suffered hepatic encephalopathy
D-dimer independently correlated with 28-day mortality in ACLF we explored the correlation between D-dimer levels and 28-day prognosis
Summary
Acute-on-chronic liver failure (ACLF) is a syndrome characterized by profound disrupted coagulation and fibrinolysis. Acute-on-chronic liver failure (ACLF) is a syndrome characterized by acute decompensation of chronic liver disease associated with organ failures and high short-term mortality [1,2,3]. Coagulation failure reflected by elevated international normalized ratio of the prothrombin time (INR) levels was one of the most common signs of disease in ACLF patients [1, 4]. INR is based on the levels of procoagulant factors and not anticoagulant factors. It is regarded as an accurate marker of liver function, rather than a predictor of bleeding or thrombosis [5], which do not adequately reflect the hemostatic status in patients with liver disease.
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