title: Bacterial infection in cirrhosis impairs coagulation by a heparin effect: a prospective study.
abstract: BACKGROUND
  Bacterial infections have been postulated as a trigger for variceal bleeding in cirrhotic patients, and impair coagulation evaluated by thrombelastography (TEG). Endogenous heparinoids have been detected after variceal bleeding and during liver transplantation in some cirrhotics using heparinase-modified-TEG.
  
  
  OBJECTIVE
  To assess if bacterial infection is associated with endogenous heparinoids in cirrhotics, thus impairing coagulation.
  
  
  METHODS
  Native and heparinase-modified-TEG (cleavage of heparin and heparan-sulphate) was performed in 60 cirrhotics (Grade A, 2; B, 30; C, 28): 30 infected [septicaemia, 6 (culture positive); 6 (culture negative); spontaneous bacterial peritonitis, 10; chest infection, 4; others, 4], 30 not infected, and five infected patients without liver diseases, comparing TEG parameters r, alpha, and ma. Eight cirrhotics were studied before and after infection. The diagnosis of presence and type of infection was based on international standard criteria.
  
  
  RESULTS
  A significant heparin effect was found only in infected cirrhotics (28 of 30) with significant changes in r (P=0.0003), alpha (P<0.0001), and ma (P<0.0001), but in none of those not infected. This effect completely reversed in the eight evaluated after resolution of infection. There was no heparin effect in infected non-cirrhotics.
  
  
  CONCLUSIONS
  A heparin effect was only found in cirrhotic patients with infection, further confirming that infection significantly modifies coagulation in cirrhotic patients.
authors.affiliation: Liver Transplantation and Hepatobiliary Medicine, Royal Free Hospital, Pond Street, London NW3 2QG, UK.
authors.forename: Paolo
authors.initials: P
authors.lastname: Montalto
authors.forename: Jiannis
authors.initials: J
authors.lastname: Vlachogiannakos
authors.forename: Dominic J
authors.initials: DJ
authors.lastname: Cox
authors.forename: Sabrina
authors.initials: S
authors.lastname: Pastacaldi
authors.forename: David
authors.initials: D
authors.lastname: Patch
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Burroughs
mesh_terms: D000328:Adult; D001424:Bacterial Infections / Q000150:complications* / Q000503:physiopathology*; D001777:Blood Coagulation; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000382:microbiology; D006493:Heparin / Q000378:metabolism; D019763:Heparin Lyase / Q000378:metabolism; D006496:Heparinoids / Q000378:metabolism*; D006497:Heparan Sulfate / Q000378:metabolism; D006521:Hepatitis, Chronic / Q000150:complications / Q000503:physiopathology; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000150:complications / Q000503:physiopathology; D013916:Thrombelastography
chemical_list: D006493:Heparin; D019763:Heparin Lyase; D006496:Heparinoids; D006497:Heparan Sulfate