Impact of Cirrhosis on Hematological Emergencies in Patients with Gastrointestinal Cancers: A National Inpatient Sample Study
Authors: Voruganti Hima Varsha , Sekandlapuram Rohit , Sinha Samridhi , Jayakumar Jayalekshmi , Gaddam Mrunanjali , Moliya Pratiksha , Tadikonda Siri 
Published: December 2024

Impact of Cirrhosis on Hematological Emergencies in Gastrointestinal malignancies

Introduction:

Disseminated intravascular coagulation (DIC) is a complex and serious condition characterized by widespread activation of the clotting cascade, leading to the formation of blood clots throughout the small blood vessels. This can result in multiple organ dysfunction and bleeding complications due to the consumption of clotting factors and platelets. Pancreatic cancer cells often express high levels of tissue factor (TF), a key initiator of the extrinsic coagulation pathway, which is released into the bloodstream to trigger clotting, and some cancer cells also produce procoagulant proteins that can activate coagulation pathways independently of TF.

Cirrhosis also disrupts the delicate balance of the clotting cascade, leading to both increased risk of bleeding and potential clotting disorders. Our study demonstrates the impact of Cirrhosis on outcomes of DIC in pancreatic and colon cancers.

Methods:

We queried the National Inpatient Sample (NIS) database (2018 to 2020) for adult hospitalizations (aged over 18) with diagnoses of Pancreatic cancer, Gastric cancer, and Colon cancer, identified through relevant ICD-10 codes. These hospitalizations were categorized based on the presence or absence of Cirrhosis. To assess the impact of Cirrhosis on outcomes, we performed a multivariate regression analysis, with disseminated intravascular coagulation (DIC) and mortality as the primary outcomes of interest.

Results:

Among a total of 394,269 adult hospitalizations for pancreatic cancer, 12,219 were complicated by cirrhosis. The mean age of hospitalisations for pancreatic cancer with cirrhosis was 66 years, compared to 68 years for those without cirrhosis. Similarly, of the 1,277,319 adult hospitalizations for colon cancer, 26,514 involved coexisting cirrhosis, with both groups having a mean age of 65 years.

Multivariate regression analysis indicated that hospitalizations for pancreatic cancer with cirrhosis were associated with significantly higher odds of DIC [OR: 1.68, p=0.01] and mortality [OR: 1.26, p=0.00] compared to those without cirrhosis. Likewise, colon cancer hospitalizations with cirrhosis also demonstrated elevated odds of DIC [OR: 2.76, p=0.00] and mortality [OR: 1.76, p=0.00] relative to those without cirrhosis.

Conclusion:

The presence of cirrhosis worsens the outcomes of DIC in pancreatic and colon cancer patients by impairing clotting factor production, reducing natural anticoagulants, and disrupting platelet function. The presence of DIC in a patient with pancreatic cancer is often indicative of advanced disease and can significantly impact clinical management. Therefore meticulous monitoring is essential for these patients. Also, further research is necessary to enhance the early detection of disseminated intravascular coagulation (DIC) in patients with cirrhosis and cancer.