Clinical Significance of Haemostatic Tests in Chronic Liver Disease

Objective: To determine different haemostatic tests in patients with variousdegrees of liver parenchymal damage and to rule out their role in assessingparenchymal hepatocyte dysfunction. Methods: Seventy-five patients withchronic liver disease were included and due to their degree of liver damage categorizedinto three groups: group one patients with chronic viral hepatitis and earlystage of fibrosis (n=30), group two patients with compensated cirrhosis (n=17) andgroup three patients with decompensated liver cirrhosis (n=28). The following haemostatictests were measured: activated partial thromboplastin time, prothrombintime, plasma fibrinogen, antithrombin III and protein C and plasma D-dimer. Results:Antithrombin III levels showed significant reduction in compensated (83.86± 19.49%) and decompensated cirrhosis (52.64 ± 14.31%; p 0.001), while protein Cactivity exhibited significant decrease in all the patients group, including patientswith chronic viral hepatitis (90.58 ± 11.03, 74.65± 19.56, 41.11 ± 18.35%; p 0.001) incomparison with controls. Correlation between antithrombin III (Pearson ro= -,931,p 0,01) and protein C (Pearson ro= -,789, p 0,01) and clinical degree of chronic liverdisease were found. D-dimer levels were significantly increased in decompensatedcirrhosis (832.26 ± 537.19 ìg/L; p 0.001) and no significant difference was foundin group two and three when compared with healthy controls. Conclusions: Inadvanced chronic liver disease anticoagulant activitiy may reflect hepatocellulardysfunction. Protein C activity may be used as a senstive marker of hepatocellulardamage even in those patients with mild liver affection whereas D-dimer levels maybe considered as an important sign of decompensation in cirrhotic patients. Furtherstudies are necessary to approve whether these parameters could be used as clinicalroutine markers of hepatocyte function in chronic liver disease.