Evaluation of D-dimer and factor VIII in cirrhotic patients with asymptomatic portal venous thrombosis.
D-dimer and factor VIII levels raise in advanced cirrhosis. We investigated the behavior and the diagnostic usefulness of D-dimer and factor VIII in cirrhotic patients with asymptomatic portal venous thrombosis. Factor VIII coagulant and D-dimer values were measured in 136 consecutive outpatients with stable cirrhosis divided according to Child-Pugh (CP) classification, who underwent color/power ultrasonography to detect portal thrombosis. Portal thrombosis was found in 33 patients (24.2%). In patients without thrombosis, factor VIII was significantly higher in CP class C compared with class A and B. Conversely, class C patients with portal thrombosis had lower factor VIII levels than those without thrombosis. In both groups, D-dimer was significantly increased in class C compared with class A and B. In class C, thrombotic patients showed higher D-dimer values than did patients without thrombosis. In class C, a D-dimer value > or = 0.55 microg/mL provided a sensitivity and a negative predictive value for portal thrombosis of 100%, and a factor VIII coagulant level < or = 80% showed a specificity and a negative predictive value of 76% and 84%, respectively. In class B, a D-dimer value > or = 0.225 microg/mL had a sensitivity of 89% and a negative predictive value of 82%. In conclusion, our study shows that factor VIII values increase in severe cirrhosis but significantly decrease in the presence of concomitant portal thrombosis, likely because of consumption during thrombosis; D-dimer is enhanced by both liver failure and portal thrombosis; in severe cirrhosis, normal D-dimer and factor VIII values may safely exclude the presence of asymptomatic portal thrombosis.
Fimognari
Filippo Luca
FL
Division of Internal Medicine, ASL Roma G/Parodi-Delfino Hospital, Colleferro, Rome, Italy.
De Santis
Adriano
A
Piccheri
Cristina
C
Moscatelli
Rosanna
R
Gigliotti
Francesca
F
Vestri
Annarita
A
Attili
Adolfo
A
Violi
Francesco
F
D000368:Aged; D015415:Biomarkers / Q000097:blood; D005169:Factor VIII / Q000378:metabolism*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D006801:Humans; D008102:Liver Circulation; D008103:Liver Cirrhosis / Q000453:epidemiology / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D011237:Predictive Value of Tests; D015995:Prevalence; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D020246:Venous Thrombosis / Q000175:diagnosis* / Q000453:epidemiology / Q000378:metabolism*
D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D005169:Factor VIII