Hepatic microcirculatory thrombosis in acute-on-chronic hepatic failure

Ehab F Mostafa,Sameh Saber,Ayman Marei,Waleed A Ismael,Amr El Hawary

doi:10.4103/ejim.ejim_5_18

Abstract

BackgroundAcute-on-chronic hepatic failure is an increasing number of identified distinct disorders encompassing an acute deterioration of hepatic functions in patients with chronic liver diseaseAimThe aim was to evaluate the possibility of hepatic microcirculatory thrombosis in acute-on-chronic hepatic failure and the value of plasma fibrin monomer (FM) and D-dimer in the diagnosis.Patients and methodsA total of 50 patients with chronic hepatitis C infection developing new-onset ascites, encephalopathy, and/or jaundice with raised international normalisation ratio (INR) (group 1); group 2 included 30 patients with compensated chronic hepatitis C virus infection who served as the control group. Ascetic fluid examination and culture were done for group 1, in addition to complete blood count, liver enzymes, INR, serum bilirubin and albumin, blood culture, α-fetoprotein, D-dimer, plasma FM, abdominal ultrasound, and Doppler for portal vein were done for all patients groups.ResultsGroup 1was subdivided according to the level of FM into subgroups A and B. FM showed a significant difference between group 1A and other groups; group IB showed nonsignificant elevation of the level of FM and a significant increase in D-dimer compared with the control group. A marked reduction in portal flow mean velocity in group 1A was recorded with further deterioration of portal flow direction after 2 weeks from the admission time. Three months follow-up showed significant reduction of FM, improvement of portal flow mean velocity and direction in group 1A; FM was significantly positively correlated with portal flow mean velocity.ConclusionHepatic microcirculatory thrombosis may occur in acute-on-chronic hepatic disease; determination of the FM and D-dimer level may be useful biomarkers predicting hepatic microcirculatory thrombosis.

Highlights

The term acute-on-chronic hepatic failure (ACLF) was first utilized in 1995 to portray a condition in which two insults to the liver are working all the while, one of them being chronic and progressing whereas the other being acute [1]
The first was advanced by the Asia-Pacific Association for the Study of the Liver which provided the first consensus on ACLF, defined as ‘an acute hepatic insult manifesting as jaundice and coagulopathy, complicated within 4 weeks by ascites and/or encephalopathy’; the 2014 definition was further expanded to include ‘high 28-day mortality’ [2,3]
Our study aims to evaluate the possibility of developing hepatic microcirculatory thrombosis in ACLF and the value of plasma fibrin monomer (FM) and D-dimer assay in the diagnosisof such condition in chronic hepatitis C virus patients

Summary

Introduction

The term acute-on-chronic hepatic failure (ACLF) was first utilized in 1995 to portray a condition in which two insults to the liver are working all the while, one of them being chronic and progressing whereas the other being acute [1]. The first was advanced by the Asia-Pacific Association for the Study of the Liver which provided the first consensus on ACLF, defined as ‘an acute hepatic insult manifesting as jaundice and coagulopathy, complicated within 4 weeks by ascites and/or encephalopathy’; the 2014 definition was further expanded to include ‘high 28-day mortality’ [2,3]. They proposed: ‘acute deterioration of current chronic hepatic disease’, typically in reference to a triggering event combined with higher mortality rate at 3 months due to multisystem organ failure [4]. Three months follow-up showed significant reduction of FM, improvement of portal flow mean velocity and direction in group 1A; FM was significantly positively correlated with portal flow mean velocity

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