Prognostic value of clotting and fibrinolytic systems in a follow-up of 165 liver cirrhotic patients. CALC Group.
One hundred sixty-five patients with cirrhosis diagnosed by needle liver biopsy were followed for 2 years to evaluate the relation between clotting factors and survival. Patients with spontaneous bacterial peritonitis, hepatic carcinoma, and cholestatic liver diseases were excluded. Patients were classified as A (n = 34), B (n = 75), or C (n = 56) according to Child-Pugh criteria. During the follow-up 45 patients died of liver failure or gastrointestinal hemorrhage. Nonsurvivor patients had significantly higher values of bilirubin and D-dimer, a marker of fibrinolysis in vivo, lower values of albumin, prothrombin activity, fibrinogen, prekallikrein, factor VII, and a more prolonged activated partial thromboplastin time than survivors. All these variables and Child-Pugh classification were significantly associated with survival in a univariate analysis. Multivariate analysis (Cox's model) showed that only prekallikrein and factor VII were independently predictors of survival. Ninety-three percent of patients with prekallikrein values < 32% died within 32 months of follow-up, whereas factor VII < 34% identified 93% of patients who died within 10 months of follow-up. This study suggests that factor VII is an early predictor of survival and may be a useful test to better identify cirrhotic patients who should be candidates for liver transplantation.
Violi
F
F
Instituto di I Clinica Medica, Universita, La Sapienza, Policlinico Umberto I, Roma, Italy.
Ferro
D
D
Basili
S
S
Cimminiello
C
C
Saliola
M
M
Vezza
E
E
Cordova
C
C
D000368:Aged; D001777:Blood Coagulation; D005167:Factor VII / Q000032:analysis; D005260:Female; D005342:Fibrinolysis; D005500:Follow-Up Studies; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011288:Prekallikrein / Q000032:analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D016019:Survival Analysis
D005167:Factor VII; D011288:Prekallikrein