Clinical significance of the change in plasma D-dimer in patients with hepatitis B cirrhosis / 临床肝胆病杂志

ABSTRACT

ObjectiveTo investigate the correlation between plasma D-dimer level and severity of hepatitis B cirrhosis and its value in the diagnosis of portal vein thrombosis (PVT). MethodsA retrospective analysis was performed for the clinical data of 500 patients with hepatitis B cirrhosis who were hospitalized in The Fifth Medical Center of Chinese PLA General Hospital from January to December, 2018, and according to the plasma level of D-dimer, they were divided into normal group with 217 patients and elevated group with 283 patients. The correlations of plasma D-dimer level with Child-Pugh class and Model for End-Stage Liver Disease (MELD) score were compared between the two groups. The t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the Kruskal-Wallis H test was used for multiple groups comparison and further pairwise comparison. The chi-square test was used for comparison of categorical data between two groups. A Spearman correlation analysis was used to investigate correlation. The receiver operating characteristic (ROC) curve was used to evaluate the early warning performance of D-dimer level for PVT in patients with hepatitis B cirrhosis. ResultsThere were significant differences between the two groups in D-dimer level, alanine aminotransferase, aspartate aminotransferase, total bilirubin, albumin, Child-Pugh class, MELD score, and incidence rate of PVT (all P＜0.05). The correlation analysis showed that plasma D-dimer level was positively correlated with Child-Pugh class and MELD score in both groups (r=0.463, 0.455, 0.214, and 0.756, all P＜005). A total of 50 patients with hepatitis B cirrhosis were found to have PVT; the patients with PVT had a significantly higher D-dimer level that those without PVT ［1.96 (0.82-4.91) mg/L vs 0.61 (0.19-1.54) mg/L, Z=-6.02, P＜0.001］. The ROC curve analysis showed that D-dimer level had an area under the ROC curve of 0.758 (95% confidence interval 0.719-0.796) at the optimal cut-off value of 0.76 mg/L. ConclusionPlasma D-dimer level is correlated with the severity of hepatitis B cirrhosis and can be used to predict the prognosis of patients with hepatitis B cirrhosis. The possibility of PVT should be considered in patients with an elevated D-dimer level.