PROGNOSTIC VALUE OF CLOTTING AND FIBRINOLYTIC SYSTEMS IN A FOLLOW-UP OF 165 LIVER CIRRHOTIC-PATIENTS

One hundred sixty-five patients with cirrhosis diagnosed by needle liv er biopsy were followed for 2 years to evaluate the relation between c lotting factors and survival. Patients with spontaneous bacterial peri tonitis, hepatic carcinoma, and cholestatic liver diseases were exclud ed. Patients were classified as A (n = 34), B (n = 75), or C (n = 56) according to Child-Pugh criteria, During the follow-up 45 patients die d of liver failure or gastrointestinal hemorrhage. Nonsurvivor patient s had significantly higher values of bilirubin and D-dimer, a marker o f fibrinofysis in vivo, lower values of albumin, prothrombin activity, fibrinogen, prekallikrein, factor VII, and a more prolonged activated partial thromboplastin time than survivors. All these variables and C hild-Pugh classification were significantly associated with survival i n a univariate analysis. Multivariate analysis (Cox's model) showed th at only prekallikrein and factor VII were independently predictors of survival. Ninety-three percent of patients with prekallikrein values < 32% died within 32 months of follow-up, whereas factor VII <34% identi fied 93% of patients who died within 10 months of follow-up. This stud y suggests that factor VII is an early predictor of survival and may b e a useful test to better identify cirrhotic patients who should be ca ndidates for liver transplantation.