O-25 BACTERIAL INFECTION ENHANCES THROMBIN GENERATION IN PATIENTS WITH CIRRHOSIS
Introduction and Aims: Current concept of coagulopathy in cirrhosis indicates that there is a rebalancing of hemostasis with plasma hypercoagulability. Bacterial infection can promotes releases of endothelial heparinoids. However, the effect of this condition on the thrombin generation is unknown. O...
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doaj-f3c602160a634010913d32fcfb6e10a02021-09-29T04:24:25ZengElsevierAnnals of Hepatology1665-26812021-09-0124100512O-25 BACTERIAL INFECTION ENHANCES THROMBIN GENERATION IN PATIENTS WITH CIRRHOSISMarina Pamponet Motta0Elbio Antonio D'Antonio D'Amico1Tânia Rubia Flores da Rocha2Beatriz Yuri Migita3Juliana Medeiros Batista4Caroline Marcondes Ferreira5Flair José Carrilho6Alberto Queiroz Farias7Department of Gastroenterology, University of Sao Paulo School of MedicineCoagulation Laboratory, Division of Hematology, University of Sao Paulo School of MedicineCoagulation Laboratory, Division of Hematology, University of Sao Paulo School of MedicineDepartment of Gastroenterology, University of Sao Paulo School of MedicineDepartment of Gastroenterology, University of Sao Paulo School of MedicineDepartment of Gastroenterology, University of Sao Paulo School of MedicineDepartment of Gastroenterology, University of Sao Paulo School of MedicineDepartment of Gastroenterology, University of Sao Paulo School of MedicineIntroduction and Aims: Current concept of coagulopathy in cirrhosis indicates that there is a rebalancing of hemostasis with plasma hypercoagulability. Bacterial infection can promotes releases of endothelial heparinoids. However, the effect of this condition on the thrombin generation is unknown. Our aim was to assess the effect of bacterial infection on thrombin generation in cirrhosis. Methods: 36 patients with cirrhosis and bacterial infection (infected group) were evaluated within 24 hours after start antibiotic and at least 5 days after infection resolution. 28 patients with decompensated cirrhosis and not infected (not infected group) were also enrolled and reevaluated, without any intervention between evaluation times. Primary endpoint was the effect of bacterial infection on thrombin generation (TG) parameter ETP with TM (ETP TM). TM is a protein C activator added to mimic in vivo conditions. ROTEM assays, INTEM and HEPTEM (heparinase modified), was performed to evaluate the endogenous heparinoids effect. Protein C (PC) and antithrombin (AT) assays were performed. All results were compared within each group between evaluation times. Results: ETP TM values in infected cirrhotics were significantly higher than after resolution of infection (from 1145.4 ± 360.7 nmol/L*min to 958.1 ± 254.8 nmol/L*min, p=0.005) - figure 1. A heparinoid effect was found only in infected cirrhotics, with CTINTEM duration significantly longer than CTHEPTEM (p=0.004). This effect disappeared after resolution of infection (p=0.75). PC and AT deficiencies were significantly more severe in infected patients (p<0,01). RNI/TP, aPTT was worsen at active infection (p<0.05). None of these parameters exhibited a significant difference between inclusion and revaluation times in not infected group. Conclusion: patients with cirrhosis exhibits significant higher amount of TG during bacterial infection and it is associated with reduction of PC and AT levels. Despite the endogenous heparinoid effect during infection in cirrhosis, plasma hypercoagulability is preserved and cannot be assessed by conventional coagulation tests.http://www.sciencedirect.com/science/article/pii/S1665268121002118 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Marina Pamponet Motta Elbio Antonio D'Antonio D'Amico Tânia Rubia Flores da Rocha Beatriz Yuri Migita Juliana Medeiros Batista Caroline Marcondes Ferreira Flair José Carrilho Alberto Queiroz Farias |
spellingShingle |
Marina Pamponet Motta Elbio Antonio D'Antonio D'Amico Tânia Rubia Flores da Rocha Beatriz Yuri Migita Juliana Medeiros Batista Caroline Marcondes Ferreira Flair José Carrilho Alberto Queiroz Farias O-25 BACTERIAL INFECTION ENHANCES THROMBIN GENERATION IN PATIENTS WITH CIRRHOSIS Annals of Hepatology |
author_facet |
Marina Pamponet Motta Elbio Antonio D'Antonio D'Amico Tânia Rubia Flores da Rocha Beatriz Yuri Migita Juliana Medeiros Batista Caroline Marcondes Ferreira Flair José Carrilho Alberto Queiroz Farias |
author_sort |
Marina Pamponet Motta |
title |
O-25 BACTERIAL INFECTION ENHANCES THROMBIN GENERATION IN PATIENTS WITH CIRRHOSIS |
title_short |
O-25 BACTERIAL INFECTION ENHANCES THROMBIN GENERATION IN PATIENTS WITH CIRRHOSIS |
title_full |
O-25 BACTERIAL INFECTION ENHANCES THROMBIN GENERATION IN PATIENTS WITH CIRRHOSIS |
title_fullStr |
O-25 BACTERIAL INFECTION ENHANCES THROMBIN GENERATION IN PATIENTS WITH CIRRHOSIS |
title_full_unstemmed |
O-25 BACTERIAL INFECTION ENHANCES THROMBIN GENERATION IN PATIENTS WITH CIRRHOSIS |
title_sort |
o-25 bacterial infection enhances thrombin generation in patients with cirrhosis |
publisher |
Elsevier |
series |
Annals of Hepatology |
issn |
1665-2681 |
publishDate |
2021-09-01 |
description |
Introduction and Aims: Current concept of coagulopathy in cirrhosis indicates that there is a rebalancing of hemostasis with plasma hypercoagulability. Bacterial infection can promotes releases of endothelial heparinoids. However, the effect of this condition on the thrombin generation is unknown. Our aim was to assess the effect of bacterial infection on thrombin generation in cirrhosis. Methods: 36 patients with cirrhosis and bacterial infection (infected group) were evaluated within 24 hours after start antibiotic and at least 5 days after infection resolution. 28 patients with decompensated cirrhosis and not infected (not infected group) were also enrolled and reevaluated, without any intervention between evaluation times. Primary endpoint was the effect of bacterial infection on thrombin generation (TG) parameter ETP with TM (ETP TM). TM is a protein C activator added to mimic in vivo conditions. ROTEM assays, INTEM and HEPTEM (heparinase modified), was performed to evaluate the endogenous heparinoids effect. Protein C (PC) and antithrombin (AT) assays were performed. All results were compared within each group between evaluation times. Results: ETP TM values in infected cirrhotics were significantly higher than after resolution of infection (from 1145.4 ± 360.7 nmol/L*min to 958.1 ± 254.8 nmol/L*min, p=0.005) - figure 1. A heparinoid effect was found only in infected cirrhotics, with CTINTEM duration significantly longer than CTHEPTEM (p=0.004). This effect disappeared after resolution of infection (p=0.75). PC and AT deficiencies were significantly more severe in infected patients (p<0,01). RNI/TP, aPTT was worsen at active infection (p<0.05). None of these parameters exhibited a significant difference between inclusion and revaluation times in not infected group. Conclusion: patients with cirrhosis exhibits significant higher amount of TG during bacterial infection and it is associated with reduction of PC and AT levels. Despite the endogenous heparinoid effect during infection in cirrhosis, plasma hypercoagulability is preserved and cannot be assessed by conventional coagulation tests. |
url |
http://www.sciencedirect.com/science/article/pii/S1665268121002118 |
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