Clinical correlation between coagulation disorders and sepsis in patients with liver failure

Article type: Research Article

Authors: Li, Lei^{a; 1} | Chen, Ling^{a; 1} | Wang, Han^{b; 1} | Li, Peiran^c | Wang, Dan^a | Zhang, Wei^a | Mi, Lai^a | Lin, Fang^d | Qin, Yuling^{a; *} | Zhou, Yuesu^{a; *}

Affiliations: [a] Department of Emergency, Fifth Medical Center of Chinese PLA Hospital, Beijing, China | [b] Department of Blood Transfusion, Fifth Medical Center of Chinese PLA Hospital, Beijing, China | [c] Department of Clinical Laboratory, Fifth Medical Center of Chinese PLA Hospital, Beijing, China | [d] Department of Critical Care Medicine, Fifth Medical Center of Chinese PLA Hospital, Beijing, China

Correspondence: [*] Corresponding author: Yuesu Zhou and Yuling Qin, Department of Emergency, Fifth Medical Center of Chinese PLA Hospital, No. 100 Middle Road of West 4th Ring Road, Fengtai District, Beijing 100039, China. Tel./Fax: +86 10 66933202; E-mail: yuesu_zhou@163.com. (Yuesu Zhou); E-mail: ylqin90@163.com (Yuling Qin).

Note: [1] These authors contributed equally to this study.

Abstract: OBJECTIVE:This study aimed to explore the clinical detection and prognosis of coagulation function in patients with liver failure and sepsis. METHODS:The plasma fibrinogen (FIB), factor II, factor VII, factor V, factor IV, antithrombin III (ATIII), platelet (PLT), mean PLT volume (MPV), D-dimer, prothrombin activity (PTA), and fibrin degradation product (FDP) levels and thromboelastogram values were detected in patients with liver failure complicated with sepsis and compared with those in the liver failure and liver cirrhosis groups. The patients with liver failure complicated with sepsis were analyzed by univariate and multivariate logistic regression, and the regression equation was established. RESULTS:The levels of FIB, factor II, factor VII, factor V, ATIII, PLT, MPV, D-dimer, and FDP in the patients with liver failure complicated with sepsis were compared with those in the control group patients, and the differences were statistically significant (p < 0.05). Among the thromboelastography parameters in the patients with liver failure and sepsis, the differences in the K-value, R-value, angle, maximum amplitude, and coagulation index values compared with those of the control group were statistically significant (p < 0.05). The logistic regression model obtained was as follows: p = 1/(1 + e [–0.128×X1–0.058×X2 + 0.211×X3 + 0.2×X4 + 0.25]). The specificity, sensitivity, and accuracy values of the regression equation in determining the prognosis were 92%, 93.9%, and 92.8%, respectively. Among the 11 factors, factor VII, PLT, FDP, and D-dimer were included in the regression equation. CONCLUSION:Coagulation disorder is exacerbated in patients with liver failure and sepsis. Among the 11 coagulation-related factors, factor VII, PLT, FDP, and D-dimer may be the independent factors influencing the prognosis of patients with acute liver failure and sepsis.

Keywords: Liver failure, coagulation disorders, sepsis, coagulation factor, prognosis

DOI: 10.3233/CH-211113

Journal: Clinical Hemorheology and Microcirculation, vol. 80, no. 3, pp. 219-231, 2022