studies

HEPATOLOGY, VOLUME 62, NUMBER 1 (SUPPL) AASLD ABSTRACTS 579A
740
Hemostatic profiles in liver disease: novel evidence of
mixed phenotype in critically-ill patients with cirrhosis
and liver failure and implications for clinical management
of hemostatic disturbance.
Vishal C. Patel 1 , Arjuna Singanayagam 1 , Jelle Adelmeijer 2 , Julia
Wendon 1 , William Bernal 1 , Ton Lisman 2 ; 1 Liver Intensive Therapy
Unit, Kings College Hospital, London, United Kingdom; 2 Surgical
Research Laboratory, University Medical Center Groningen, Groningen,
Netherlands
Background Hemostatic disturbance is ubiquitous in critically-ill
patients with cirrhosis and liver failure but there is lack of
evidence to guide management. Studies in patients with compensated
cirrhosis suggests a ‘rebalanced’ or pro-thrombotic
state, but very limited data exists as to that present in those with
decompensated disease or acute on chronic liver failure. We
performed detailed evaluation of hemostatic profiles in patients
with liver failure of varying severity, comparing to those in
healthy controls. Patients and Methods Hemostatic profiles
were determined in patients on admission to a single centre
with stable (SC, n=4: median age 55 yrs (IQR 42-76); male
75%) and decompensated (DC, n=22; 58 yrs (56-63); M 59%)
cirrhosis and Acute on Chronic Liver Failure (ACLF, n=5; 60
yrs (43-67), M 80%) ) and Healthy Controls (HC, n=19; 38 yrs
(33-41); M 47%). MELD score was 8 (7-11) in SC, 14 (10-27)
in DC and 38 (23-40) in ACLF. Assays included plasma von
Willebrand Factor (VWF), its regulator ADAMTS13, Thrombin
generation in the presence and absence of thrombomodulin
(TM) to activate protein C, and clot lysis time to test fibrinolytic
capacity. Results As compared to HC, VWF was elevated in
all patient groups, with levels increasing with disease severity:
SC 247% [124-467], p=ns, DC 591% [389-842], P