Bile acids and coagulation factors:  paradoxical association in children with chronic liver disease.
OBJECTIVE
To examine whether there is an association between bile acids and coagulation factors in children with chronic liver disease.


METHODS
Forty-five patients (age 2.8 months-18.8 years) were included in this cross-sectional observational study carried out at a single tertiary referral center. Coagulation factors, prothrombin time, albumin, and total fasting serum bile acids were analyzed. The international normalized ratio (INR) and the pediatric end-stage liver disease score were calculated.


RESULTS
The 12 patients with bile acids more than 200 μmol/l showed a significant positive correlation between bile acids and factor V (FV), FVII, and prothrombin time (r(s) = 0.80, 0.72, 0.60, P<0.05) and a significant negative correlation between bile acids and INR (r(s) = -0.58, P<0.05). Conversely, in the group with bile acids less than 200 μmol/l, there was a significant negative correlation between bile acids and FVII and FIX (r(s) = -0.41 and -0.41, P<0.05) and a positive, albeit nonsignificant, correlation between bile acids and INR. No in-vitro analytical interference between bile acids and coagulation factors was found. Patients with bile acids more than 200 μmol/l had a significantly worse outcome than patients with lower levels of bile acids.


CONCLUSIONS
A positive correlation was found between bile acids and coagulation factors in patients with bile acids more than 200 μmol/l. Coagulation factors may be questionable as prognostic markers in patients with markedly elevated bile acids.
CLINTEC, Division of Pediatrics, Karolinska Institutet, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden. maria.magnusson@ki.se
Maria
M
Magnusson
Björn
B
Fischler
Jan
J
Svensson
Pia
P
Petrini
Sam
S
Schulman
Antal
A
Németh
D000293:Adolescent; D001647:Bile Acids and Salts / Q000097:blood* / Q000494:pharmacology; D015415:Biomarkers / Q000097:blood; D001779:Blood Coagulation Factors / Q000032:analysis* / Q000187:drug effects; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007223:Infant; D019934:International Normalized Ratio; D008107:Liver Diseases / Q000097:blood*; D008297:Male; D012709:Serum Albumin / Q000032:analysis
D001647:Bile Acids and Salts; D015415:Biomarkers; D001779:Blood Coagulation Factors; D012709:Serum Albumin