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D-dimer and fibrinolytic activity in patients with decompensated liver cirrhosis
Abstracts / Digestive and Liver Disease 47S (2015) e19–e42
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D-DIMER AND FIBRINOLYTIC ACTIVITY IN PATIENTS WITH DECOMPENSATED LIVER CIRRHOSIS
SURVIVAL OF PATIENTS WITH HEPATOCELLULAR CARCINOMA (HCC) WITHIN THE BOLOGNA LIVER ONCOLOGY GROUP: COMPARISON WITH INTERNATIONAL GUIDELINES
R.G. Romanelli a , A.P. Cellai b , D. Lami b , F. Natucci a , C. Tosti-Guerra a , R. Abbate b , D. Prisco b , G. Laffi a a
Dipartimento Medicina Clinica e Sperimentale (DMSC) Liver Unit, Italy b Sezione delle Malattie Aterotrombotiche del Dipartimento dell’Area Critica Medico Chirurgica Università di Firenze - Azienda Ospedaliero Universitaria Careggi (AOUC), Firenze, Italy Background and Aims: Cirrhotic plasma could generate similar or even greater amount of thrombin; a procoagulant imbalance has been introduced. Ascitic fluid has been hypothesized to be the origin of hyperfibrinolysis. Standard tests (INR) fail to really reflect bleeding tendency. Aim of this study was to determine whether a fibrinolytic activity is detectable in ascites. Material andMethods: We evaluated 33 patients with liver cirrhosis (11 in Child-Pugh class A, score 5.6, mean age 65 ± 11 (yrs); 9 in Child-Pugh class B, score 7.9, mean age 69 ± 17 (yrs); 13 in Child-Pugh class C, score 11.4, mean age 70 ± 12 (yrs) and 21 control healthy subjects, mean age 68 ± 14 (yrs). We studied Clot Lysis Time (CLT), D-dimer, tissue plasminogen activator (t-PA), plasminogen activator inhibitor (PAI-1), alpha2-antiplasmin (a2AP), plasminogen (PLG), thrombin activatable fibrinolysis inhibitor (TAFI), and (through EuroCLOT) clot formation, structure, and lysis. Results: We found that a2AP (%), PLG (%), TAFI (mg/mL) and fibrinogen (mg/dl) levels were significantly higher in plasma than ascites (p < 0.001) and lower in plasma from patients than controls (p < 0.05). Instead, D-dimer levels (ng/ml) were significantly lower in plasma than in ascitic fluid (p < 0.001), whereas similar concentrations were found for t-PA and PAI-1. D-dimer, PAI-1 and t-PA levels were significantly higher (p < 0.05) and CLT shorter in plasma from patients than from healthy subjects (p < 0.05). By EuroCLOT, statistically significant differences were observed between cirrhotic patients and healthy controls (AUC control subjects: 585; Child-Pugh A 316*; Child-Pugh B 257*; Child-Pugh C 129*** (from p < 0.05* to p < 0.001***). Conclusion: Cirrhotic patients show hyperfibrinolytic activity versus healthy subjects. In ascitic fluid from cirrhotic patients high levels of D-dimer were found. These data further suggest that ascitic fluid compartment is in continuous exchange with plasmatic compartment, possibly through lymphatic flux, and contributes to the coagulopathy of liver cirrhosis. http://dx.doi.org/10.1016/j.dld.2015.01.073
e33
E. Terzi, M. Piccinnu, F. Piscaglia, S. Leoni, A. Granito, L. Bolondi, on the behalf of the BLOG-Bologna Liver Oncology Group Division of Internal Medicine, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy Introduction: The Barcelona Clinic Liver Cance system (BCLC), endorsed by the latest international EASL-EORTC and AASLD guidelines, represents the reference therapeutic and prognostic staging system. Aim: was to evaluate the overall survival and clinical determinants of survival in our series of HCC patients and to compare the results to those of guidelines eventually attempting to identify reasons for discrepancy. Materials and Methods: Among 1028 HCC patients referred to our center between January 2000 and August 2013, we retrospectively identified the outcome of the 595 consecutive patients seen in our center on occasion of the first diagnosis of HCC. Results: Stage was BCLC-0 in 23 patients (4%), BCLC-A in 273 (46%,), BCLC-B in 155 (26%), BCLC-C in 114 (19%) and BCLC-D in 30 patients (4%). Median survival in BCLC-0 was 88 months (95% C.I. 41.3-134.7) with 1-, 3- and 5-year survival rates of 97%, 86% and 61%; in BCLC-A was 44 months (95% C.I. 37.4-50.4) with 1-, 3- and 5-year survival rates of 92%, 60% and 36%; in BCLC-B was 20 months (95% C.I. 14.2-25.8) with 1-, 3- and 5-year survival rates of 65%, 34% and 21%; in BCLC-C was 8 months (95% C.I. 5.2-10.8) with 1-, 3- and 5-year survival rates of 39%, 2% and 0%; in BCLC-D was 7 months (95% C.I. 4.8-12.2). At multivariate survival analysis, age > 67 years, neoplastic portal vein thrombosis, AFP > 19 ng/mL and BCLC C-D were statistically associated with shorter survival. Conclusion: The present study validates survival data reported by the guidelines in a large unselected series of consecutive patients with HCC managed under real life conditions. Such results were achieved through a multidisciplinary and individually tailored treatment strategy of HCC patients within the Bologna Liver Oncology Group (BLOG). http://dx.doi.org/10.1016/j.dld.2015.01.074 T-32 TACE WITH CONE BEAM COMPUTED TOMOGRAPHY IS MORE EFFECTIVE THAN TRADITIONAL TECHNIQUE IN BCLC A HCC PATIENTS INELIGIBLE TO SURGERY R. Patti 1,2 , N. Mezzina 1,2 , F. Masutti 1,2 , C. Abazia 1,2 , V. Lanzillotti 1,2 , D. Pascut 2 , C. Sukowati 2 , F. Pozzi Muceli 3 , C. Tiribelli 1,2 , S.L. Crocè 1,2 1 Dipartimento di Scienze Mediche, Clinica Patologie del Fegato, Università di Trieste, Trieste 2 Fondazione Italiana Fegato, Italy 3 Dipartimento di Scienze Mediche, UCO di Radiologia, Università di Trieste, Trieste
Introduction: In the last years despite the improvement in cancer diagnostic and therapeutic tools HCC mortality is still high. The decision-making process in HCC treatment is mainly based on the
T-30
T-31
D-DIMER AND FIBRINOLYTIC ACTIVITY IN PATIENTS WITH DECOMPENSATED LIVER CIRRHOSIS
SURVIVAL OF PATIENTS WITH HEPATOCELLULAR CARCINOMA (HCC) WITHIN THE BOLOGNA LIVER ONCOLOGY GROUP: COMPARISON WITH INTERNATIONAL GUIDELINES
R.G. Romanelli a , A.P. Cellai b , D. Lami b , F. Natucci a , C. Tosti-Guerra a , R. Abbate b , D. Prisco b , G. Laffi a a
Dipartimento Medicina Clinica e Sperimentale (DMSC) Liver Unit, Italy b Sezione delle Malattie Aterotrombotiche del Dipartimento dell’Area Critica Medico Chirurgica Università di Firenze - Azienda Ospedaliero Universitaria Careggi (AOUC), Firenze, Italy Background and Aims: Cirrhotic plasma could generate similar or even greater amount of thrombin; a procoagulant imbalance has been introduced. Ascitic fluid has been hypothesized to be the origin of hyperfibrinolysis. Standard tests (INR) fail to really reflect bleeding tendency. Aim of this study was to determine whether a fibrinolytic activity is detectable in ascites. Material andMethods: We evaluated 33 patients with liver cirrhosis (11 in Child-Pugh class A, score 5.6, mean age 65 ± 11 (yrs); 9 in Child-Pugh class B, score 7.9, mean age 69 ± 17 (yrs); 13 in Child-Pugh class C, score 11.4, mean age 70 ± 12 (yrs) and 21 control healthy subjects, mean age 68 ± 14 (yrs). We studied Clot Lysis Time (CLT), D-dimer, tissue plasminogen activator (t-PA), plasminogen activator inhibitor (PAI-1), alpha2-antiplasmin (a2AP), plasminogen (PLG), thrombin activatable fibrinolysis inhibitor (TAFI), and (through EuroCLOT) clot formation, structure, and lysis. Results: We found that a2AP (%), PLG (%), TAFI (mg/mL) and fibrinogen (mg/dl) levels were significantly higher in plasma than ascites (p < 0.001) and lower in plasma from patients than controls (p < 0.05). Instead, D-dimer levels (ng/ml) were significantly lower in plasma than in ascitic fluid (p < 0.001), whereas similar concentrations were found for t-PA and PAI-1. D-dimer, PAI-1 and t-PA levels were significantly higher (p < 0.05) and CLT shorter in plasma from patients than from healthy subjects (p < 0.05). By EuroCLOT, statistically significant differences were observed between cirrhotic patients and healthy controls (AUC control subjects: 585; Child-Pugh A 316*; Child-Pugh B 257*; Child-Pugh C 129*** (from p < 0.05* to p < 0.001***). Conclusion: Cirrhotic patients show hyperfibrinolytic activity versus healthy subjects. In ascitic fluid from cirrhotic patients high levels of D-dimer were found. These data further suggest that ascitic fluid compartment is in continuous exchange with plasmatic compartment, possibly through lymphatic flux, and contributes to the coagulopathy of liver cirrhosis. http://dx.doi.org/10.1016/j.dld.2015.01.073
e33
E. Terzi, M. Piccinnu, F. Piscaglia, S. Leoni, A. Granito, L. Bolondi, on the behalf of the BLOG-Bologna Liver Oncology Group Division of Internal Medicine, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy Introduction: The Barcelona Clinic Liver Cance system (BCLC), endorsed by the latest international EASL-EORTC and AASLD guidelines, represents the reference therapeutic and prognostic staging system. Aim: was to evaluate the overall survival and clinical determinants of survival in our series of HCC patients and to compare the results to those of guidelines eventually attempting to identify reasons for discrepancy. Materials and Methods: Among 1028 HCC patients referred to our center between January 2000 and August 2013, we retrospectively identified the outcome of the 595 consecutive patients seen in our center on occasion of the first diagnosis of HCC. Results: Stage was BCLC-0 in 23 patients (4%), BCLC-A in 273 (46%,), BCLC-B in 155 (26%), BCLC-C in 114 (19%) and BCLC-D in 30 patients (4%). Median survival in BCLC-0 was 88 months (95% C.I. 41.3-134.7) with 1-, 3- and 5-year survival rates of 97%, 86% and 61%; in BCLC-A was 44 months (95% C.I. 37.4-50.4) with 1-, 3- and 5-year survival rates of 92%, 60% and 36%; in BCLC-B was 20 months (95% C.I. 14.2-25.8) with 1-, 3- and 5-year survival rates of 65%, 34% and 21%; in BCLC-C was 8 months (95% C.I. 5.2-10.8) with 1-, 3- and 5-year survival rates of 39%, 2% and 0%; in BCLC-D was 7 months (95% C.I. 4.8-12.2). At multivariate survival analysis, age > 67 years, neoplastic portal vein thrombosis, AFP > 19 ng/mL and BCLC C-D were statistically associated with shorter survival. Conclusion: The present study validates survival data reported by the guidelines in a large unselected series of consecutive patients with HCC managed under real life conditions. Such results were achieved through a multidisciplinary and individually tailored treatment strategy of HCC patients within the Bologna Liver Oncology Group (BLOG). http://dx.doi.org/10.1016/j.dld.2015.01.074 T-32 TACE WITH CONE BEAM COMPUTED TOMOGRAPHY IS MORE EFFECTIVE THAN TRADITIONAL TECHNIQUE IN BCLC A HCC PATIENTS INELIGIBLE TO SURGERY R. Patti 1,2 , N. Mezzina 1,2 , F. Masutti 1,2 , C. Abazia 1,2 , V. Lanzillotti 1,2 , D. Pascut 2 , C. Sukowati 2 , F. Pozzi Muceli 3 , C. Tiribelli 1,2 , S.L. Crocè 1,2 1 Dipartimento di Scienze Mediche, Clinica Patologie del Fegato, Università di Trieste, Trieste 2 Fondazione Italiana Fegato, Italy 3 Dipartimento di Scienze Mediche, UCO di Radiologia, Università di Trieste, Trieste
Introduction: In the last years despite the improvement in cancer diagnostic and therapeutic tools HCC mortality is still high. The decision-making process in HCC treatment is mainly based on the