Plasma level of tissue factor pathway inhibitor in children with chronic liver disease

Tissue factor pathway inhibitor [TFPI] is one of physiological coagulation inhibitors, which when decreased may facilitate coagulation especially in advanced liver disease. The aim of this study is to measure the Plasma level of [TFPI] in patients with chronic liver disease [CLD] of various etiologies and correlate this with other parameters routinely used to assess these patients. We measured Plasma level of [TFPI] in 50patients with [CLD] using a specific ELIZA test along with 10 matched healthy controls. The children were classified into 6 groups, group [I] control group:n=10, group [II] those with chronic HBV and HCV viral infection ; n=17, group [III] a metabolic one ; n=9, group [IV] those with autoimmune hepatitis ; n=10, group [V] patients with biliary disorders ; n = 9 and group [VI] hepatovascular group ; n = 5. All children were also subjected to clinical exam,. Liver function tests, PT and conc, PTT, Plasma level of protein C and factor V, serum fibrinogen, HBSAg, anti HBc total and IgM, anti HCV, HCV-RNA for anti HCV +/- ve patients, ultrasound and liver biopsy was done for 36 patients. The result showed that TFPI was decreased in different types of CLD irrespective to the etiology compared to control group group [I]: 83.2 +/- 18.50ng/mL, group[II]30.9 +/- 20.2 ng/mL, group[III]: 57.5 +/- 21.5 ng/mL, group [IV]: 58 +/- 24.5 ng/mL, group [V]: 35.9 +/- 16.9 ng/mL and group[VI]: 71.2 +/- 47.1 ng/mL. The results gave a statistically sig. value in all groups except group [VI]. There was no sig. difference between cirrhotics and non cirrhotics regarding TFPI Plasma level, [non cirrhotics: 41.2 +/- 23.1 ng/mL ; n=18, cirrohtics: 54.5 +/- 33.2 ng/mL; n =32 The study also showed a sig. decrease of TFPI with disease progression child A cirrohtics: 73.8 +/- 36.46 ng/mL ; n = 7, child B: 52.7 +/- 14.6 ng/mL; n = 4, child C: 36.2 +/- 29.33 ng/mL; n = 7. There was no sig, correlation between TFPI plasma level and AST, ALT . ALP, GGT, protein C and factor V but a sig. one was found with serum fibrinogen and PTT

Tissue factor pathway inhibitor assay in neonatal septicemia

Coagulation is probably initiated when factor VII or Vll7a in blood gains access to TF at the site of a blood vessel wound. The resulting factor Vlla -TF complex then activates some factors X to Xa and IX to IXa with the initial generation of factor Xa, however the inhibitory properties of TFPl become manifest and inactivate factor Vlla-TF. This study aimed to assess the TFPl level in 25 neonate with clinical and laboratory findings of septicemia and 70 healthy neonates as a control group. There was a significant decrease in TFPl and fibrinogen in diseased group than control [47.4 +/- 78.5 vs 92.7 +/- 77.4 ng/ml and 235.6 +/- 63.7 vs 427.2 +/- 44.5 mg/dl respectively] and increased PTT and CRP in diseased group than control [73 +/- 38.1 vs 26.9 +/- 1.1 and 52.2 +/- 23.3 vs 4.7 +/- 1.0 respectively]

Conclusion: TFPl is decreased in neonatal septicemia mostly due to its consumption due to activation of the coagulation pathway by the tissue factor and there is no correlation between TFPl and CRP, PT and LDL. A large study is needed to assess TFPl in different causes of infection and the possible role of the recombinant TFPl in ameliorating sepsis if possible