Assessment of D-dimer and protein S in Egyptian patients with cirrhosis with and without ascites

• Published in: The Egyptian journal of haematology : the official journal of the Egyptian Society of Haematology 2018-10, Vol.43 (4), p.166-170
• Main Authors: Ibrahim, Wesam, Safwat, Nesma, Ibrahim, Mohamed, Djibrin, Millimi
• Format: Article
• Language: English
• Subjects: Ascites; EDTA; Egyptians; Health aspects; Liver; Liver cirrhosis; Medical research; Protein S
• ISSN: 1110-1067; 2090-9268
• DOI: 10.4103/ejh.ejh_25_18

Background Liver cirrhosis is characterized by complex hemostatic defects, leading to both hemorrhagic and thrombotic complications. It is also associated with ascites. Being a derivative of plasma that accumulates in the abdominal cavity from transudative leakage out of cirrhotic liver and because ascites re-enters the systemic circulation, cirrhotic ascites may be a pathological fluid that contributes to hemostatic derangement in these patients. The aim of study was to measure plasma levels of d-dimer and protein S (PS) activity as hemostatic parameters in patients with cirrhosis of varying severity with and without ascites to evaluate the role of ascites as a contributor of coagulopathy associated with liver cirrhosis. Patients and methods A total of 90 patients with cirrhosis with varying degree of severity owing to hepatitis C admitted to Ain Shams University hospitals from January 2017 to January 2018 were included in this study. Patients were categorized into two groups: group I included patients with cirrhosis complicated with ascites (n=38), and group II included patients with cirrhosis without ascites (n=52). The severity of liver disease was assessed according to the Child-Pugh classification. Plasma samples from each patient were analyzed for the level of d-dimer and PS activity. Results Plasma d-dimer levels showed a significant increase in patients with ascites (2.04±0.38 mg/l) when compared with those without. However, PS activity was significantly decreased in presence of ascites (45.79±1.66%). These changes appeared to be significantly accompanied by the progression of liver dysfunction. Upon performing regression analysis (backward method), it was proved that ascites formation was a significant independent factor that increases d-dimer levels and deteriorates PS activity in patients with cirrhosis. Conclusion Our results suggest that ascites contributes to the coagulopathy in decompensated liver disease, and the degree of coagulopathy was proportional to the severity of liver disease.