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Haemostatic Disorders and their Correlation with Hepatic Fibrosis Markers in Case of Hepatic Cirrhosis in Children

E. Konovalova, A. Lavrova, M. Presnyakova

Federal State-Financed Educational Institution of Higher Education Research Medical University of Volga Region of the Russian Ministry of Public Health, Nizhny Novgorod, Russian Federation

Abstract Number: PB1244

Meeting: ISTH 2020 Congress

Theme: Pediatrics » Bleeding in Neonates and Children

Background: Currently data is increasingly accumulated on the correlation of hepatic diseases and coagulation disorders and on the role of haemostatic proteins in the hepatic fibrosis pathogenesis.

Aims: To assess haemostatic disorders and their correlation with hepatic fibrosis markers in children suffering from hepatic cirrhosis.

Methods: The study group consisted of 31 children with hepatic cirrhosis aged between 3 and 17 years old. To assess haemostatic disorders, there were determined the platelet count, the activated partial thromboplastin time (APTT), thrombin time, the Quick’s prothrombin activity (PT), antithrombin activityIII, C-protein, vonWillebrand factor (VWF), plasminogen, alpha-2-ntiplasmin (α-2AP), XIIa-dependent fibrinolysis, fibrinogen content, SFC (soluble fibrin complexes), D-dimers, endothelin-1. The concentration of the following hepatic fibrosis markers was also determined: collagen IV, the platelet-derived growth factor (PDGF). The control group (n=15) consisted of children included in health groups I-II.
Statistic methods: Mann-Whitney U-test, Spearman’s rank correlation coefficient. Quantitative data are herein presented as Me (Q1;Q3).
The study was approved by the Local Ethics Committee (Protocol No.16, December 5, 2017). All the study participants signed their informed consent.

Results: The clinical evidence of haemorrhagic events (ecchymoses, petechiae, frequent nosebleeds) was recorded in each second patient. Changes in the haemostatic system were characterized by liability to thrombocytopenia, endothelium hyperthrombogenicity and moderate decrease in the coagulation, anticoagulant and fibrinolytic activity (Table 1). All patients had higher concentrations of hepatic fibrosis markers, which were directly correlated with indicators of coagulation hemostasis, anticoagulant system and endothelium dysfunction markers (Table2).

Indicator The study group n=31 The control group n=15 р
Thrombocytes, (109/l) 150(117; 212) 311.0(266.0;349.0) р=0.000
Endothelin-1, (fmol/ml) 1.80(0.82; 5.05) 0.55(0.22; 0.63) р=0.000
VWF, (%) 167.5(149.0; 267.0) 76.6 (58.85;105.4) р=0.000
APTT, (s) 40.4(34.2; 42.4) 30.53(28.9; 33.2) р=0.000
PT (%) 81.0(70.0; 88.5) 102.5(89.0; 124.0) р=0.000
С-protein, (%) 69.4(59.0; 86.3) 99.5(88.1; 113.1) р=0.002
α2-AP, (%) 81.3(63.0; 95.8) 115.8(102.1; 124.6) р=0.000
Collagen IV, ng/ml 50.55(29.67; 74.20) 18.48(14.12;21.31) р=0.000
PDGF, pg/ml 4137.5(2812.5; 5677.9) 2862.6(2462.4; 3437.6) р=0.045

[Table 1Changes in hemostasiologic indicators and fibrosis markers (Me (Q1;Q3)) (Note: n is the number of observations, р is the significance level)]

Fibrosis markers Haemostatic indicators Spearman’s rank correlation coefficient (r) p
Collagen IV VWF r=0.519 р=0.019
Collagen IV Endothelin – 1 r=0.527 р=0.012
Collagen IV Quick’s PT r= – 0.453 р=0.023
Collagen IV С-protein r= – 0.482 р=0.031
PDGF VWF r=0.661 р=0.002
PDGF Endothelin – 1 r=0.600 р=0.005
PDGF Quick’s PT r= – 0.459 р=0.027

[Table 2 Correlation relationships of haemostatic indicators and fibrosis markers (Spearman’s method) (Note: р is the reliability of correlation relat)]

Conclusions: Haemostatic disorders in case of cirrhosis are directly correlated with fibrosis markers. So, it proves their role in the fibrogenesis development and determines the need to monitor all links of the haemostatic system in order to comprehensively assess the disease severity and to prevent the further progression of grave complications. Financing: the research was completed under the Governmental task for 2017-2020.

To cite this abstract in AMA style:

Konovalova E, Lavrova A, Presnyakova M. Haemostatic Disorders and their Correlation with Hepatic Fibrosis Markers in Case of Hepatic Cirrhosis in Children [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/haemostatic-disorders-and-their-correlation-with-hepatic-fibrosis-markers-in-case-of-hepatic-cirrhosis-in-children/. Accessed May 16, 2022.

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