title: Disseminated intravascular coagulation in liver cirrhosis.
abstract: We measured thrombin-antithrombin III complex (TAT), soluble fibrin (SF) and D-dimer levels in 51 patients with liver cirrhosis to determine whether these tests provide new evidence for the presence of disseminated intravascular coagulation (DIC) in liver cirrhosis. TAT levels (median, range) were increased in the patient group (4.2 micrograms/l, 1.8-60.0) compared to the reference group (2.0 micrograms/l, range 1.5-7.6 micrograms/l). SF levels (0 nmol/l, range 0-80 nmol/l) were also increased in the patients as compared to the controls (0 nmol/l, 0), but there was no correlation between TAT and SF levels (r = 0.23, p less than 0.98). TAT levels did not correlate with AT-III levels (r = -0.36, p less than 0.49), but there was an inverse correlation between SF and AT-III (r = 0.60, p less than 0.001). If AT-III levels were above 0.30 U/ml, SF levels remained low, whereas SF levels were increased in patients with AT-III levels below 0.30 U/ml. These findings suggest that if sufficient AT-III is present, thrombin formation is adequately controlled, whereas at low levels of AT-III, thrombin escapes inactivation by AT-III and may act upon fibrinogen, leading to the formation of SF and a low-grade DIC. SF levels correlated well with D-dimer levels (r = 0.55, p less than 0.001), which is consistent with DIC and secondary fibrinolysis.
  
  
  CONCLUSIONS
  (1) thrombin formation is increased in liver cirrhosis, as indicated by increased TAT levels in 21 of 51 patients; (2) the plasma concentration of AT-III appears to be of major importance for the development of DIC. The present study provides evidence for DIC in severe liver cirrhosis when AT-III levels are less than 0.30 U/ml.
authors.affiliation: Department of Internal Medicine, University Hospital, Rotterdam, The Netherlands.
authors.forename: C M
authors.initials: CM
authors.lastname: Bakker
authors.forename: E A
authors.initials: EA
authors.lastname: Knot
authors.forename: J
authors.initials: J
authors.lastname: Stibbe
authors.forename: J H
authors.initials: JH
authors.lastname: Wilson
mesh_terms: D000328:Adult; D000368:Aged; D000990:Antithrombin III / Q000032:analysis; D004211:Disseminated Intravascular Coagulation / Q000097:blood / Q000150:complications*; D005260:Female; D005337:Fibrin / Q000032:analysis; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010447:Peptide Hydrolases / Q000032:analysis; D013223:Statistics as Topic
chemical_list: C046193:antithrombin III-protease complex; D000990:Antithrombin III; D005337:Fibrin; D010447:Peptide Hydrolases