Coagulopathy And D-dimer Level Changes In Chronic Liver Disease And Cirrhosis
Authors: Hezam ABDO Ali , Alqubati Khalid 
Published: November 2024

Abstract

Background: The liver is the largest organ in the body, Chronic liver disease consists of chronic hepatitis and cirrhotic hepatic. The liver has a cardinal role in the haemostatic system. Liver synthesizes plasma proteins including many coagulation proteins e.g., Factor I, II, V, VII, VIII, IX, X, XI, XII, XIII, many natural anticoagulants like protein C & S. Chronic or acute liver diseases frequently have an intense impact on the haemostatic system Bleeding in liver disease could be due to decreased plasma levels of haemostatic proteins synthesized by the liver. It could also be due to thrombocytopenia, coagulopathy, enhanced fibrinolysis or portal hypertension. Recent studies have shown that patients with liver disease also develop deep venous thrombosis and pulmonary artery embolism at rates between 0.5%-1.9%
Aims:
The aims of this study are to evaluate the coagulopathy status and D-dimer level changes in context of severity of CLD and cirrhosis including their correlation with disease progression and severity.
Patients and methods:
Observational, cross-sectional study. any patient aged ≥ 18 years old, confirmed clinically and para-clinically had CLD either with or without liver cirrhosis, and attended to Al-Sadaqah hospital-Taiz for treatment and follow up, through 1st January, 2021 to 30th December, 2022.
Result: One hundred fourteen patients classified according to Child Paugh score. Of total, A, B and C and were 10.5%, 26.3%, and 63.2%; 63.2% was male. 3.5%, 31.6%, 14%, 33.3%, 10.5% and 7% was fallen in < 20, 20-29, 30-39, 40-49, 50-59 and ≥60 years old; all patients were Khat chewers while only 17.5% were active smokers, all of active smokers found in Child-Pugh C. Autoimmune hepatitis followed by HBV, Bilharziasis and HCV found in 36.8%, 21.1%, 12.3% and 7% of total patients respectively, 22.8% were of unknown etiology. All patients presented with current history of increased fatiguability. Distended abdomen, discoloration of the body, GIT bleeding, Change LOC and Anuria and accounting of 89.5%, 70.2%, 56.1%, 52.6% and 3.5% of total patients respectively. Vital signs were taken in ER on arrival, systolic blood pressure, diastolic blood pressure and heart rate were recorded for all patients. Of note, there is a difference of statistically significance among Child-Pugh groups regarding their blood pressure and heart rate, sustainable hypotension was found in C and B while tachycardia was recorded in all A and some of B and little of C. S platelets count ranged between 26-216(130.5), 115-198(174), 56-163(131), and 26-216(129) of total, Child-Pugh A, B and C respectively. All thrombocytic patients below 50k found in Child-Pugh C, bellow 100k found in C and B. PT(seconds) ranged between 15-50(18), 17-18(18), 15-18(16.5), and 17-50(23.75) and INR(%) ranged between 1.13-3.8(1.4), 1.2-1.4(1.4), 1.13-1.4(1.4), and 1.3-3.8(1.8) for total, Child-Pugh A, B, and C respectively. D-dimer ranged between 320-10000(5127), 320-560(460), 950-8870(1800), and 1143-10000(6200) for total, Child-Pugh A, B, and C respectively. of note, D-dimer of Child-Pugh patients found within normal cut off point of 500.
Conclusion: Coagulopathy and bleeding tendency in direct proportion with severity of chronic liver diseases defined by Child-Pugh score. D dimer correlated well with advanced stages of liver disease even in absence of thrombotic events.