Predictive role of Natural Anticoagulants in Prognosis of Chronic Liver Disease in Pediatric Age Group

Abstract

Background: In asymptomatic peadiatric patients, cirrhosis is considered to be compensated, with or without gastroesophageal varices, it may be decompensated. Both Antithrombin III, Protein C and D dimers are sensitive markers of liver disease.

Objective: To determine the frequency of compensated and decompensated cirrhosis in cirrhotic peadiatric patients and compare the status of protein C, Antithrombin lll deficiency and D-dimer in both groups.

Methodology: In this cross sectional study, 80 peadiatric patients suspected to have cirrhosis were included, from November, 2015 to April, 2016, by non-probability convenience sampling. Variables included were; compensated and decompensated chronic liver disease, Antithrombin III, D dimer and Protein C, as natural anticoagulents. Data was analyzed by SPSS 13.

Results: Out of 80 patients, 70 (87.5%) were in the compensated phase of cirrhosis. Mean Antithrombin III showed significant reduction in patients with decompensated cirrhosis (50.0±4.05%) when compared with patients with compensated liver disease (84.52 ±15.36%). Mean Protein C level exhibited also significant reduction in the decompensated patient groups (40±4.7%) when compared with the compensated group of patients (77.92±6.67%). The mean D-dimer levels showed significantly higher levels only in patients with signs of decompensated cirrhosis (840±11.85μg/L) when compared with compensated disease (629±6.29).

Conclusion: Our study concluded that the natural anticoagulants Antithrombin III, Protein C and D dimer, reflect hepatocellular impairment in both compensated as well as decompensated peadiatric patients of cirrhosis. However, these are markedly decreased in decompensated disease except for D dimer.

Key words: Cirrhosis, Anti-thrombin III, Protein C, Protein S, D-dimer.