Prolonged PT Research Articles

Gastrointestinal and hepatobiliary manifestations of COVID-19 infection: A single center study from Pakistan

BACKGROUND: Coronavirus disease was a global challenge affecting around 229 countries with over 700 million confirmed cases with significant morbidity and mortality. OBJECTIVE: To determine the frequency of hepatobiliary manifestations in patients of COVID-19. METHODOLOGY: This was a cross-sectional study conducted at North Medical Ward, Mayo Hospital, Lahore for three months. After ethical approval of the study, 200 COVID-19 RT-PCR positive cases of ages 15 to 80 years were included in the study. Complete history & examination regarding hepatobiliary symptoms were noted. Liver function tests & prothrombin time were sent to pathology laboratory & results were noted. Data was analyzed using SPSS-26. Quantitative variables like age, bilirubin, Aminotransferases & Prothrombin time were taken as mean ± standard deviation. Qualitative variables like gender, hepatobiliary symptoms were taken as frequency and percentages. RESULTS: The most common symptom at presentation was diarrhea 30 (15.0%) followed by fatigue, pruritic and anorexia 17 (8.5%), nausea, vomiting and abdominal pain 15 (7.5%), body petechiae & purpura in 13(6.5%), Right hypochondrial pain 11(5.5%) & Hiccup and dark color urine 1(0.5%). On laboratory findings,17(8.5%) patients had elevated bilirubin levels while AST was raised in 79(39.5%) of cases, ALT in 23(11.5%), Alkaline phosphatase in 6(3.0%), GGT in 95(47.5%) of cases. 8 (4.0%) cases showed decrease albumin level and 12(6.0%) cases had prolonged PT levels. CONCLUSION: Hepatobiliary symptoms and laboratory derangements are not uncommon in patients with COVID-19. So, attention should be given to these extra-pulmonary symptoms to avoid any delay in treatment & disease progression and complications.

Clinical, Hematological and Biochemical Profile of Dengue Syndromesin Children

Background: Dengue is a viral disease transmitted by mosquito bites with arising global incidence, more commonly afflicting children in endemic countries such as Bangladesh. Among the severe forms, such as dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS), there are hematological and biochemical complications. This study aims to evaluate the clinical, hematological and biochemical predictor of severity in pediatric dengue syndromes with the intention of improved clinical management. Methods: A cross sectional analytical study conducted at the Department of Pediatrics, Dhaka Medical College Hospital from April 2019 to March 2020. A total of 350 hospitalized children aged 1 month to 12 years with confirmed dengue positive were included in this study. Descriptive statistics were performed on clinical symptoms, hematological parameters and biochemical markers in order to test corresponding standard significance tests. Results: The most common symptoms were high grade fever (93.14%); vomiting (78.86%); abdominal pain (43.14%). 14.85% of DSS cases had severe thrombocytopenia (<20,000 cells/mm³). 13.86 % of DSS cases had elevated hematocrit (>45 %). In severe cases there were biochemical derangements including high SGPT (59.76% in DHF) and prolonged PT (>16 seconds). In DSS 35.15% were hypoproalbuminemic (< 3.0 gm/dl). Expanded dengue syndrome was characterized by hypocalcemia (62.5%) and elevated serum creatinine (25%). Conclusion: The clinical and laboratory markers highlighted here for early detection of severe dengue in children will help in early intervention to reduce morbidity and mortality.

Comparison of Clinical Characteristics and Mortality Outcome in Critical COVID-19 Patients Infected with Alpha and Omicron Variants.

Early reports have indicated that the Omicron variant of coronavirus disease 2019 (COVID-19) may be associated with low mortality. However, the mortality rate of critical patients in Taiwan with COVID-19 caused by different variants has not been well described. This retrospective cohort study was conducted at the Linkou Branch of Chang Gung Memorial Hospital, Taiwan, from April 2020 to September 2022. Critically ill patients who had confirmed SARS-CoV-2 infection and were on mechanical ventilation (MV) were enrolled. Demographic data, laboratory results, and treatment information were collected and analyzed. In addition, clinical outcomes for different SARS-CoV-2 variants were analyzed. This study included 110 critical patients with COVID-19 who required intubation and intensive care unit (ICU) admission. Among these patients, 46 (41.8%) required intensive care during Alpha predominance period and 64 (58.2%) during the Omicron predominance period. The Alpha group had a higher body mass index, had a longer ICU stay, and included more patients with acute respiratory distress syndrome, and the Omicron group included more active smokers, had more comorbidities, had worse initial laboratory data (including higher white blood cell counts, prothrombin time [PT], activated partial prothrombin time, blood urine nitrogen levels, and creatine levels), and had higher in-hospital mortality rates (40.6% vs 15.2%, p = 0.004). The independent risk factors for in-hospital mortality, were Charlson Comorbidity Index (CCI) ≥ 3 and higher PT and creatine levels. Our study discovered that CCI ≥ 3, elevated serum creatine levels, and prolonged PT were independently associated with a high mortality rate in patients with critical COVID-19. Patients with those risk factors may require intensive monitoring during their treatment course.

Acquired factor Ⅴ inhibitor induced by surgical trauma complicated with fatal hemorrhage: a case report and literature review

Objective: To explore the diagnosis, treatment, and prognosis of patients with acquired factor Ⅴ inhibitors. Methods: We analyzed a case of acquired factor Ⅴ inhibitor treated in the department of critical care medicine at Shanghai East Hospital in 2022. A literature review was conducted using the search terms [ ("Factor V" OR "Factor V Inhibitors") AND ("Autoantibodies" OR "Immune System Diseases") ] AND [acquired (Title/Abstract) OR autoimmune (Title/Abstract) OR inhibitor (Title/Abstract) ] in the PubMed database. Chinese databases (Wanfang, VIP, and CNKI) were searched using (acquired factor V inhibitor OR acquired coagulation factor V inhibitor OR coagulation factor V antibody OR coagulation factor V autoantibody) AND (deficiency OR inhibition OR dysfunction) . Results: A 56-year-old male was admitted to the department of critical care medicine due to coagulopathy following surgery. Laboratory tests showed normal blood routine but revealed prolonged PT of 76.7 s, APTT of 83.1 s, and an INR of 7.14. Coagulation factor assays indicated factor V activity at 8.4%, which continued to decline. Immediate and 2-hour delayed mixing studies failed to correct the coagulation abnormalities. The factor V inhibitor titer was measured at 8 BU/ml. It was considered that surgical trauma induced the production of an acquired factor V inhibitor, leading to fatal bleeding. After treatment with corticosteroids, cyclophosphamide, and plasma exchange, the coagulation abnormalities were corrected. The literature search identified 16 cases reported in China and approximately 200 cases reported globally. Conclusion: Patients with acquired factor V inhibitors exhibit diverse clinical manifestations. Current treatment options include combined therapies such as supportive care, corticosteroids, immunosuppressants, and plasma exchange. The prognosis of patients depends on the inducing factors and the timeliness of diagnosis and treatment.

Hypoprothrombinemia-lupus anticoagulant syndrome: a case report and literature review

The Hypoprothrombinemia-Lupus Anticoagulant Syndrome (HLAS) is a rare coagulation disorder, typically presenting with bleeding manifestations. It is characterized by decreased prothrombin activity and the presence of lupus anticoagulant, but laboratory findings are complex, which can delay diagnosis and treatment. This report describes the diagnosis and management of a HLAS patient who was an 11-year-old girl with recurrent bleeding. Coagulation tests revealed prolonged APTT and PT, decreased prothrombin activity, and immediate inhibitory antibodies in the APTT correction test. Lupus anticoagulant, antiphospholipid antibodies, anti-β(2)-glycoprotein 1 antibodies, and phosphatidylserine/prothrombin (aPS/PT) antibodies were positive, leading to a diagnosis of Hypoprothrombinemia-Lupus Anticoagulant Syndrome. The patient was also diagnosed with systemic lupus erythematosus. Following corticosteroid therapy, prothrombin activity returned to normal.

A study of clinical profile and outcome of patients with snake bite-induced acute kidney injury.

Snake bite is a well-known occupational hazard amongst farmers, plantation workers, and other outdoor workers and results in much morbidity and mortality throughout the world. The complications related to kidneys are observed in most patients with snake bites admitted to a hospital. The current study aimed to study the renal involvement in patients with snake bites with reference to clinical features and the time of onset of acute renal failure. A prospective clinical study of 68 patients of snake bite was done to know the clinical profile and outcome in Gandhi Hospital Secunderabad and cases were particularly looked for development of acute kidney injury. Later each case was studied and investigated with respect to onset, clinical features, course in the hospital, need for renal replacement therapy including dialysis, and mortality due to AKI. Patients were followed up till discharge or death. They were treated as per protocol. The incidence of AKI was 29.1%. Common signs and symptoms were fang mark (100%), swelling (91.2%), tenderness (91.2%), bleeding manifestations (79.4%) oliguria (26.47%), anuria (5.8%), and haematuria (8.8%). Hypotension was present in 73%, which may be the cause of AKI. All the AKI patients showed coagulation abnormalities in the form of prolonged BT, CT, PT, and aPTT. Thrombocytopenia was seen in 29.4%. All the AKI patients were given ASV for 2 to 3 days. The mean ASV vials used in the present study is 15 ± 5. Hemodialysis was done in 29.4% of patients. The cause of AKI in snakebite was multifactorial in origin. Bleeding and hypotension were among the important causes. Thrombocytopenia was significantly related to clinical bleeding. The type of snakebite is an important factor in the development of AKI and Russell's viper bite is more commonly associated with it. AKI is usually associated with oliguria and generally occurs within 48 hours.

Coagulopathies in Patients with Liver Cirrhosis Presenting to DHQ Teaching Hospital, Dera Ismail Khan

The liver develops fibrosis and nodules due to persistent damage, altering its natural lobular organization, known as cirrhosis. Various assaults such as toxic substances, viral infections, autoimmunity, or genetic disorders can damage the liver. Each lesion leads to fibrosis, or scar tissue formation, initially maintaining its functionality. Objective: To determine the frequency of coagulopathies occurring in patients with liver cirrhosis. Methods: This descriptive cross-sectional study was conducted in the General Medicine department at DHQ Teaching Hospital, D.I Khan, from June 12, 2022, to December 12, 2022. A total of 240 patients were recruited using non-probability consecutive sampling to determine the frequency of coagulopathies occurring in patients with liver cirrhosis. Coagulation tests, including prothrombin time and activated partial thromboplastin time, were performed. Data on age, gender, diabetes mellitus, hypertension, smoking status, and coagulopathies were recorded on a pre-designed proforma. Analysis was done using SPSS 20.0. Means and standard deviations were calculated for age and frequencies and percentages for categorical variables. Coagulopathies were stratified by gender, diabetes, hypertension, and smoking status to assess effect modifications. Post-stratification chi-square tests were applied, with P < 0.05 as significant. Results: The mean age was 45.56 ± 3.357 years. Males comprised 127 (52.9%) and females 113 (47.1%). Age distribution was 12.9% (20-30 years), 24.6% (31-40 years), 47.5% (41-50 years), and 15.0% (51-60 years). Coagulopathies were present in 74 (30.8%) patients, while 166 (69.2%) had none. Ninety patients (37.5%) had normal PT, lasting less than 15 seconds (mean + SD = 11.28 ± 2.02 sec), while 121 patients (50.4%) had prolonged PT (mean + SD = 22.94 ± 5.93 sec) and indicates a statistically significant difference of PT. Conclusion: Patients with cirrhosis had significantly higher and prolonged PT and APTT values, indicating an increased risk of coagulopathies.

The Correlation between Interleukin-6 and D-dimer in Severe and Critical COVID-19 Patients

Severe and critical COVID-19 patients are known to experience hyperinflammatory conditions and endothelial damage primarily characterized by increased levels of IL-6 and D-dimer. This group of patients is also considered at risk of experiencing hemostasis disorders including decreased platelet counts, prolonged PT and APTT, as well as increased fibrinogen. Therefore, this study aimed to determine the correlation between IL-6 and D-dimer in severe and critical COVID-19 patients. The relationship between IL-6 and other hemostasis parameters such as platelet count, PT, APTT, and fibrinogen were also analyzed. A descriptive-correlative observational design was used with a retrospective cross-sectional approach. The subjects were severe and critical COVID-19 patients at Hasan Sadikin Hospital, Bandung treated between January to December 2021 and met the inclusion and exclusion criteria. Secondary data were taken from medical records and the Laboratory Information System (LIS). Correlation analysis between IL-6 and D-dimer as well as hemostasis parameters was carried out using the Spearman test. The results showed that among the total 167 subjects, the median age was 60 years. The number of male subjects was 110 (65.86%), while the most common comorbidity was hypertension (45.51%). The analysis showed a very weak and insignificant correlation between IL-6 and platelets (r= -0.044; p=0.571), IL-6 and PT (r=0.115; p=0.137), IL-6 and APTT (r=0.109; p=0.159), as well as IL-6 and fibrinogen (r= -0.087; p=0.264). However, the correlation between IL-6 and D-dimer was significant (r= 0.199; p=0.010). Interleukin-6 did not correlate with hemostasis parameters but correlated with D-dimer. This means that IL-6 and D-dimer may provide information about the inflammatory response in COVID-19 patients and help monitor disease progression.

Biological Abnormalities of Hemostasis in Patients with Epistaxis or Menorrhagia in Yaoundé, Cameroon.

In Cameroon, screening and diagnosis of minor hemorrhagic syndromes remain difficult and few research studies have been done to assess the magnitude of future bleeding risk and the burden of these disorders on quality of life. Epistaxis and menorrhagia are the two leading causes of bleeding disorders in the world population. The aim of this study was to investigate the biological abnormalities of hemostasis in patients with epistaxis and menorrhagia. From January to December 2021, we conducted a cross-sectional study in six hospitals with a gynecology and ENT department. We selected patients who presented epistasis or menorrhagia through clinical file and made them pass an interview and biological exams. Venous blood collected on EDTA tube allowed us to measure full blood count, thin blood smear, and blood grouping. PT, APPT, and fibrinogen assay were measured from citrate platelet-poor plasma. This plasma stored at -20°C for a maximum of 3 months allowed us to measure vWF : Ag and vWF : CBA ELISA. The bleeding time was measured at the time of sampling. In total, our study population consisted of 60 patients aged 01-45 years. Epistaxis (40%) and menorrhagia (29%) were the two main causes of bleeding complaints in our study, in addition to gingivorrhagia (15%) and prolonged bleeding after injury (03%). Almost 60% of the population had at least one abnormal hemostasis parameter. The main abnormalities found were low von Willebrand factor (30.19%), presence of macroplatelets (16.98%), prolonged bleeding time (15.09%), prolonged PT (15.09%), and low platelet count (¬07.55%). In Cameroon, bleeding disorders manifested by epistaxis and menorrhagia are mainly caused by abnormalities of primary hemostasis.

The Mechanism of Blood Coagulation Induced by Sodium Dehydroacetate via the Regulation of the mTOR/ERK Pathway in Rats

The Mechanism of Blood Coagulation Induced by Sodium Dehydroacetate via the Regulation of the mTOR/ERK Pathway in Rats

Evaluation of Platelet and Clotting Parameters in Hematologic Malignancies and Hematopoietic Stem Cell Transplantation Patients with Candidemia

Evaluation of Platelet and Clotting Parameters in Hematologic Malignancies and Hematopoietic Stem Cell Transplantation Patients with Candidemia

Exploration of rotational thromboelastometry (ROTEM) to characterize the coagulation profiles of newly diagnosed pediatric leukemia patients

Exploration of rotational thromboelastometry (ROTEM) to characterize the coagulation profiles of newly diagnosed pediatric leukemia patients

Superior sagittal sinus thrombosis in the course of mixed phenotype acute leukaemia treated with acute lymphoblastic leukaemia-like therapy—a case report

Mixed phenotype acute leukaemia (MPAL) is associated with worse overall survival, compared with other acute leukaemias in adults. Lack of clear treatment guidelines makes the therapy challenging. ALL-like induction and consolidation treatment followed by allo-HSCT is the preferred first-line treatment. We present a case of a 36-year-old woman diagnosed with MPAL (EGIL Myelo/B) with KMT2A rearrangement, treated with the PALG-ALL-7 (including PEG-asparaginase) protocol. On day 25 after the induction therapy initiation, numbness of limbs and dizziness were observed. Therefore, the imaging studies (CT and MRI) were performed and a diagnosis of thrombosis of superior sagittal sinus of the brain was established. Routinely performed blood coagulation tests showed prolonged APTT and PT, decreased antithrombin III activity and decreased free protein S concentration. LMWH treatment and substitutional therapy with antithrombin III were started, which resulted in a significant reduction in the thrombosis associated symptoms and improvement of the neurological status after 3 days. After induction and consolidation therapy, the patient obtained complete haematological remission and negative measurable residual disease. Six months after the diagnosis, allo-HSCT was successfully performed. During the 4 months follow-up, the patient remained MRD negative and thrombotic symptoms free. To the best of our knowledge, our communication has been the first report of such complication in an MPAL patient treated with PEG-asparaginase containing protocol in adults. We recommend increased vigilance in patients manifesting any mild neurological symptoms and early decision about the MRI study performance.

Idiopathic Multicentric Castleman Disease Results in Endothelium Activation and Coagulation Dysregulation Via Tissue Factor and PAI-1

<i>Idiopathic Multicentric Castleman Disease Results in Endothelium Activation and Coagulation Dysregulation Via Tissue Factor and PAI-1</i>

Hemostatic assay in iron overloaded frequently transfused thalassemia patients.

Objective: To determine the hemostatic abnormalities in iron overloaded frequently transfused thalassemia patients. Study Design: Cross Sectional study. Setting: Departments of Pathology and Pediatric, Sheikh Zayed Medical College/Hospital, Rahim Yar Khan, Pakistan. Period: October 2022 to April 2023. Material &amp; Methods: Was conducted on 112 patients using convenient sampling. The collected data was analyzed using SPSS version 25. Results: Total 112 thalassemia patients were included in the study, 62 were male and 50 of them were female. A normal PT value was recorded in 107 (95.5%), while 5 (4.5%) had prolonged PT, a normal APTT value was recorded in 98 (87.5%), while 14 (12.5%) patients had prolonged APTT, a normal BT value was recorded in 89 (79.5%), while 23 (20.5%) patients had prolonged BT, and a normal platelet count was recorded in 86 (76.7%), while 26 (23.2%) patients had thrombocytopenia with mean level of serum ferritin was (4169.08±2193.49) and the mean age of total study subjects was (11.7 ± 3.39). Conclusion: It was concluded that high serum ferritin levels resulted in disturbance of hemostatic profile of thalassemia patients.

TO STUDY THE HEMATOLOGICAL PROFILE IN PATIENTS WITH ALCOHOLIC LIVER CIRRHOSIS IN A TERTIARY CARE HOSPITAL IN MANIPUR

Introduction: Alcoholic liver disease or alcohol-related liver disease (ALD) is damage to the liver caused by excessive alcohol consumption, resulting in serious and life-threatening complications such as cirrhosis, gastrointestinal bleeding, hepatic failure, hepatic encephalopathy and malignancy. Liver cirrhosis is defined as diffuse hepatic fibrosis with replacement of normal liver architecture by nodules. There are also lesser known sequalae including suppression of hematopoiesis due to its toxic effects, hypersplenism and nutritional deficiencies of folic acid and other vitamins. Anemia, leukocytosis, leucopenia and thrombocytopenia occurs in ALD. Most of these hematological parameters are underdiagnosed and understudied. Hence, Manipur being a high ALD prevalence state necessitates this study to evaluate the hematological profile in patients with alcoholic liver cirrhosis and to determine the association between various hematological parameters and different Model of End stage Liver Disease (MELD) scores. Methods: This cross-sectional study was conducted in Regional Institute of Medical Sciences (RIMS), Imphal, Manipur from January 2021 to October 2022.Alcoholic liver cirrhosis patients above 18 years attending Medicine OPD, Liver clinic and those admitted in Medicine ward were enrolled. Blood samples for complete Hemogram, liver function test, kidney function test, prothrombin time, INR, serology (HbsAg, Anti HCV Ab, HIV 1&amp;2) and ANA were collected. Ultrasound whole abdomen and Chest X ray were done whenever indicated. Different types of anemia, leucopenia, leukocytosis, thrombocytopenia in different groups of MELD scores were studied. Result: A total of 146 alcoholic liver cirrhosis patients were enrolled in our study. The mean ± SD age of the patients was 48.63±10.00 years with majority males (91.8%). Anemia detected in &gt;95% of the patients. Severe anemia was detected in 31.5%, moderate anemia in 49.3% and mild anemia in 15.1%. Most of them (47.9%) had leucocytosis and thrombocytopenia was seen in 78.1% patients. Prolonged PT was seen in 89.1% of the patients and elevated INR present in 69.9% of patients. Majority of patients had MELD score between 10-19 and 20-29 (34.2% each). Only 4.1% had MELD score &gt; 40. There is statistically significant association between MELD score of the patients with severity of anemia (p&lt;0.05) and leucocyte count while it is not significant with thrombocytopenia (p=0.139). Conclusion: The prevalence of anemia in the present study was found to be 94.9% with predominant normocytic normochromic anemia (71.2%). There is significant association between MELD score of the patients with severity of anemia and leukocytosis while association with thrombocytopenia was insignificant. This study can now determine the stage at which emergent intervention could help in the recovery and effectively reduce morbidity and mortality of alcoholic cirrhosis patients.

Coagulation factors as potential predictors of COVID-19 patient outcomes

BACKGROUND Causes of death and length of hospitalization in patients with COVID-19 have been associated with coagulopathy. The coagulopathy mechanism involves the process of coagulation and endothelial damage triggered by an inflammatory response of the SARS-CoV-2 infection due to excessive release of proinflammatory cytokines. This study aimed to determine the association of coagulation factors as potential predictors of COVID-19 patient outcomes.&#x0D; METHODS This retrospective study was performed on 595 patients at Wahidin Sudirohusodo Hospital, Makassar, from June 2020 to June 2021. Participants were recruited using total sampling and assessed for COVID-19 severity using the World Health Organization classification and coagulation factors (D-dimer, fibrinogen, thrombocyte, and prothrombin time [PT]). Patient outcome assessments were survival and length of hospitalization.&#x0D; RESULTS We found a significant sex-based disparity, with a higher COVID-19 incidence in males. Severe cases were more common among those aged &gt;50 years, with prolonged hospitalization (&gt;10 days) linked to higher severity (odds ratio [OR] = 2.22, 95% confidence interval [CI] = 1.31–3.77, p&lt;0.001). Elevated fibrinogen and D-dimer levels, as well as prolonged PT, predicted severe cases. However, D-dimer had the highest influence compared to other coagulation factors (OR = 14.50, 95% CI = 5.85–35.95, p&lt;0.001), while prolonged PT influenced mortality rates (OR = 4.02, 95% CI = 1.35–12.00, p = 0.01).&#x0D; CONCLUSIONS Coagulation factors, such as elevated D-dimer and fibrinogen levels and prolonged PT, predicted the severity of COVID-19 patients leading to death.

Predictors of very early death in acute promyelocytic leukemia: a retrospective real-world cohort study

Early death (ED) is still the major obstacle to cure in acute promyelocytic leukemia (APL). Most studies focus on 30-day ED; however, little is known on predictors of death before starting APL treatment (very early death — VED) and on predictors of 7-day ED, the period with most deaths due to thrombohemorrhagic diathesis. We hypothesized whether the severity of the coagulopathy of APL could predict VED and 7-day ED. We also aimed to evaluate other characteristics associated with these outcomes. We undertook a retrospective, single-center observational study including newly diagnosed APL patients admitted to our institution between January 2000 and November 2022. Baseline demographical, clinical, and laboratorial data were collected. Statistical analysis was performed using Stata. One hundred four patients were included. The VED rate was 4.8%. A DIC Score ≥ 7 (p = 0.045), serum creatinine > 1.5 mg/dL (p < 0.001%), a DIC Score ≥ 6 within 24 h (p = 0.009), and mechanical ventilation (p < 0.001) were associated with VED. The 7-day ED rate was 12.5%. High-risk (p = 0.007) and hypogranular APL (p = 0.029), DIC Score at diagnosis (p = 0.047), DIC Score ≥ 7 (p = 0.043), DIC Score ≥ 6 within 24 h (p = 0.025), PT prolongation > 6 s (p = 0.002), and creatinine > 1.5 mg/dL (p = 0.004) were associated with 7-day ED. However, only elevated creatinine emerged as an independent predictor of 7-day ED (OR 21.4; p = 0.008). Our study shows that in patients with APL, an elevated creatinine at diagnosis strongly predicts for 7-day ED. A DIC Score ≥ 7 and a Score that remains ≥ 6 within 24 h and a serum creatinine > 1.5 mg/dL significantly associated with VED.

A Study on Serum IL-6 Levels in Patients with Liver Cirrhosis of Any Cause and its Correlation with Child Pugh Score in Assessing the Disease Severity

Background: Liver cirrhosis is a chronic and progressive disease characterized by the development of fibrosis and distortion of the liver architecture. One potential biomarker that has gained attention in recent years is interleukin-6 (IL-6), a pro-inflammatory cytokine that plays a crucial role in the immune response and inflammatory processes. In the present study, serum IL-6 levels will be measured using enzyme-linked immunosorbent assay (ELISA) and correlated with the Child-Pugh score. Methods: This study was a cross-sectional design conducted at ASCOMS Jammu from June 2021 to November 2021. Fifty patients who presented with symptoms of liver cirrhosis, such as abdominal pain, abdominal distention, jaundice, and reduced urine output, were randomly selected from the outpatient or emergency departments. Results: The study analyzed data from 50 patients, finding that 6% were below the age of 30, 24% were between 30 and 40, and 70% were over 40. 94% of patients were male, while only 6% were female. The study found a significant increase in the mean portal vein diameter as the Child class increased, and a significant correlation between PT prolongation and mean IL-6 levels. However, there was no significant correlation between Child class and SAAG value. Conclusion: The severity of varices in patients with liver cirrhosis was found to be strongly associated with the level of serum IL-6, suggesting that serum IL-6 can be used as a non-invasive way to identify varices in patients with liver cirrhosis, particularly when OGD scopy is not available or if the patient is too sick to be moved to the OGD room. Elevated levels of IL-6 have also been associated with hepatic encephalopathy, liver fibrosis, and cirrhosis. Keywords: Interleukin 6, liver cirrhosis, hepatic encephalopathy, child Pugh score

COVID-19-induced coagulopathy: Experience, achievements, prospects.

The presence of coagulopathy as part of the systemic inflammatory response syndrome is a characteristic feature of severe coronavirus disease 2019 (COVID-19). Hematological changes (increased D-dimer [DD], prolonged activated partial thromboplastin clotting time [APTT] and prothrombin time [PT], high fibrinogen levels) have been observed in hospitalized patients with COVID-19, which characterize the risk of thrombotic events. Against the background of COVID-19 there is endothelial dysfunction, hypoxia and pulmonary congestion, mediated by thrombosis and microvascular occlusion. Up to 71.4% of patients who died from COVID-19 had disseminated intravascular coagulation syndrome, compared with only 0.6% of survivors. The main manifestation of COVID-19-associated coagulopathy is a significant increase in DD without a decrease in platelet count or prolongation of APTT and PT, indicating increased thrombin formation and the development of local fibrinolysis. An increase in DD levels of more than 3-4 times was associated with higher in-hospital mortality. Therefore, COVID-19 requires assessment of the severity of the disease for further tactics of thromboprophylaxis. The need for continued thromboprophylaxis, or therapeutic anticoagulation, in patients after inpatient treatment for two weeks using imaging techniques to assess of thrombosis assessment.