Potential utility of a multi-component coagulation factor panel to calculate MELD scores and assess the risk of portal vein thrombosis in chronic liver disease
Abstract Background Current quantitative approaches to assess chronic liver disease (CLD) severity have limitations. Further, portal vein thrombosis (PVT) pre-liver transplant (LT) is a major contributor to morbidity in CLD; the means of detecting and/or predicting PVT are limited. We sought to expl...
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| Format: | Article |
| Language: | English |
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BMC
2023-03-01
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| Series: | BMC Gastroenterology |
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| Online Access: | https://doi.org/10.1186/s12876-023-02695-6 |
| _version_ | 1797864564262436864 |
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| author | Clayton S. Lewis Khurram Bari Changchun Xie Kenneth E. Sherman Marc Vasse Patrick Van Dreden Vladimir Y. Bogdanov |
| author_facet | Clayton S. Lewis Khurram Bari Changchun Xie Kenneth E. Sherman Marc Vasse Patrick Van Dreden Vladimir Y. Bogdanov |
| author_sort | Clayton S. Lewis |
| collection | DOAJ |
| description | Abstract Background Current quantitative approaches to assess chronic liver disease (CLD) severity have limitations. Further, portal vein thrombosis (PVT) pre-liver transplant (LT) is a major contributor to morbidity in CLD; the means of detecting and/or predicting PVT are limited. We sought to explore whether plasma coagulation factor activity levels can serve as a substitute for prothrombin time/international normalized ratio (PT/INR) in the Model for End-stage Liver Disease (MELD), and/or help assess the risk of PVT. Methods Plasma activity levels of Factor V (FV), Factor VIII (FVIII), Protein C (PC), and Protein S (PS) and the concentrations of D-dimer, sP-selectin, and asTF were assessed in two cohorts of CLD patients (ambulatory, n = 42; LT, n = 43). Results FV and PC activity levels strongly correlated with MELD scores, which enabled the development of a novel scoring system based on multiple linear regressions of the correlations of FV and PC activity with MELD-Na that substitutes PT/INR. Six-month and 1-year follow-up revealed that our novel approach was non-inferior to MELD-Na at predicting mortality. A significant inverse correlation between FVIII activity levels and PVT was found in the LT cohort (p = 0.010); FV and PS activity levels were in-trend (p = 0.069, p = 0.064). We developed a logistic regression-based compensation score to identify patients at risk of PVT. Conclusions We demonstrate that FV and PC activity levels may be used to replace PT/INR in MELD scoring. We also show the potential of using the combination of FV, FVIII, and PS activity levels to assess the risk of PVT in CLD. |
| first_indexed | 2024-04-09T22:53:55Z |
| format | Article |
| id | doaj.art-761ed85df5c44bdd82f2eec79fb27af3 |
| institution | Directory Open Access Journal |
| issn | 1471-230X |
| language | English |
| last_indexed | 2024-04-09T22:53:55Z |
| publishDate | 2023-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Gastroenterology |
| spelling | doaj.art-761ed85df5c44bdd82f2eec79fb27af32023-03-22T11:23:01ZengBMCBMC Gastroenterology1471-230X2023-03-0123111210.1186/s12876-023-02695-6Potential utility of a multi-component coagulation factor panel to calculate MELD scores and assess the risk of portal vein thrombosis in chronic liver diseaseClayton S. Lewis0Khurram Bari1Changchun Xie2Kenneth E. Sherman3Marc Vasse4Patrick Van Dreden5Vladimir Y. Bogdanov6Division of Hematology/Oncology, Department of Internal Medicine, University of Cincinnati College of MedicineDivision of Digestive Diseases, Department of Internal Medicine, University of Cincinnati College of MedicineDepartment of Environmental and Public Health Sciences, University of Cincinnati College of MedicineDivision of Digestive Diseases, Department of Internal Medicine, University of Cincinnati College of MedicineDepartment of Biology and UMR INSERM 1176, Foch HospitalDiagnostica StagoDivision of Hematology/Oncology, Department of Internal Medicine, University of Cincinnati College of MedicineAbstract Background Current quantitative approaches to assess chronic liver disease (CLD) severity have limitations. Further, portal vein thrombosis (PVT) pre-liver transplant (LT) is a major contributor to morbidity in CLD; the means of detecting and/or predicting PVT are limited. We sought to explore whether plasma coagulation factor activity levels can serve as a substitute for prothrombin time/international normalized ratio (PT/INR) in the Model for End-stage Liver Disease (MELD), and/or help assess the risk of PVT. Methods Plasma activity levels of Factor V (FV), Factor VIII (FVIII), Protein C (PC), and Protein S (PS) and the concentrations of D-dimer, sP-selectin, and asTF were assessed in two cohorts of CLD patients (ambulatory, n = 42; LT, n = 43). Results FV and PC activity levels strongly correlated with MELD scores, which enabled the development of a novel scoring system based on multiple linear regressions of the correlations of FV and PC activity with MELD-Na that substitutes PT/INR. Six-month and 1-year follow-up revealed that our novel approach was non-inferior to MELD-Na at predicting mortality. A significant inverse correlation between FVIII activity levels and PVT was found in the LT cohort (p = 0.010); FV and PS activity levels were in-trend (p = 0.069, p = 0.064). We developed a logistic regression-based compensation score to identify patients at risk of PVT. Conclusions We demonstrate that FV and PC activity levels may be used to replace PT/INR in MELD scoring. We also show the potential of using the combination of FV, FVIII, and PS activity levels to assess the risk of PVT in CLD.https://doi.org/10.1186/s12876-023-02695-6Liver diseasesVenous thrombosisFactor VFactor VIIIProtein C |
| spellingShingle | Clayton S. Lewis Khurram Bari Changchun Xie Kenneth E. Sherman Marc Vasse Patrick Van Dreden Vladimir Y. Bogdanov Potential utility of a multi-component coagulation factor panel to calculate MELD scores and assess the risk of portal vein thrombosis in chronic liver disease BMC Gastroenterology Liver diseases Venous thrombosis Factor V Factor VIII Protein C |
| title | Potential utility of a multi-component coagulation factor panel to calculate MELD scores and assess the risk of portal vein thrombosis in chronic liver disease |
| title_full | Potential utility of a multi-component coagulation factor panel to calculate MELD scores and assess the risk of portal vein thrombosis in chronic liver disease |
| title_fullStr | Potential utility of a multi-component coagulation factor panel to calculate MELD scores and assess the risk of portal vein thrombosis in chronic liver disease |
| title_full_unstemmed | Potential utility of a multi-component coagulation factor panel to calculate MELD scores and assess the risk of portal vein thrombosis in chronic liver disease |
| title_short | Potential utility of a multi-component coagulation factor panel to calculate MELD scores and assess the risk of portal vein thrombosis in chronic liver disease |
| title_sort | potential utility of a multi component coagulation factor panel to calculate meld scores and assess the risk of portal vein thrombosis in chronic liver disease |
| topic | Liver diseases Venous thrombosis Factor V Factor VIII Protein C |
| url | https://doi.org/10.1186/s12876-023-02695-6 |
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