Soluble fibrin as a biomarker for intrahepatic microthrombosis in acute-on-chronic liver failure


Value of soluble fibrin as a biomarker for intrahepatic microthrombosis and its sequel acute-on-chronic liver failure in chronic hepatitis C patients


Ehab F. Mostafa, Waleed A. Ismail, Amr Elhwary1, Ayman M. Marei 2.

1. Internal medicine department, Hepatology divison, Zagazig University.
2. Microbiology department, Zagazig University.


International Journal of Bioscience and Medicine

Background: There is a lack in finding the precipitating factor in acute –on chronic liver failure (ACLF)insult in large number of patients and either this factor is hepatic or extra hepatic origin. Aim of the work : Our study aiming to evaluate the potential usefulness of a new plasma soluble fibirin polymer (SF) assay for diagnosing the possibility of occurrence of intrahepatic microthrombosis as a cause of ACLF in patients with chronic hepatitis C virus. Patients & Methods: The study was carried out in Zagazig University Hospital, internal medicine department in collaboration with microbiology department from February 2015 tell November 2015. 50 patients having chronic hepatitis c virus was enrolled in this study with ACLF developing new onset ascitis in 15 patient encephalopathy in 12 patients, jaundice in12 and elevated INR in 11 patients all having regular follow-up in hepatology clinic in Zagazig university Hospital with stable clinical course in the previous three months. Control subject was classified as normal subject 20 and 30 patients with compensated chronic hepatitis C virus infection. All patients and control groups were subjected to full history, complete clinical examination and laboratory tests including CBC, INR, serum albumin, serum bilirubin, liver enzymes, ascitic fluid examination and culture, blood culture, alpha-fetoprotein, d D-dimer, thrombin generation and soluble fibrin polymer., abdominal ultrasound, Doppler ultrasound for portal vein. Results: Our results showed significant difference between patients group and both  control groups regarding SF and D-dimer, also there were significant differences in patients group and other groups regarding ALT, total bilirubin especially direct bilirubin. There were marked reduction in portal flow mean velocity in patients group and other groups and we recorded further reduction in the portal flow mean velocity in patients group after 2 weeks from the starting time. There is significant positive correlation between SF and D-dimer with ALT, bilirubin, INR, portal flow mean velocity and increasing amount of ascitis and degree of encephalopathy. Conclusion: Evaluation the level of soluble fibrin polymer is a useful biomarker to predict ACLF development. Further studies are needed to insure its value and the best modality of treatment in this condition.

Research Highlights
1- Soluble fibrin as a biomarker for intrahepatic microthrombosis
2- The possibility of intrahepatic microthrombosis in developing acute-on-chronic liver failure in chronic hepatitis C patients


Keywords: Soluble fibrin, intrahepatic microthrombosis, chronic hepatitis C patients, sequel acute-on-chronic liver failure

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