Protein C-activity and protein S in chronic liver disease in children

Protein C and protein S were measured in twenty patients [13 males and 7 females] suffering from chronic liver disease. They were all attendants of the pediatric hepatology clinic, Ain Shams University. Their ages ranged between 1-12 years [mean 4.79 +/- 3.13 years]. This group was further subdivided into two subgroups group A :10 patients with liver cirrhosis and group B 10 patients with chronic active hepatitis. A comparable group of 10 healthy children served as control group.All patients as well as the controls were subjected to careful history, clinical examination and laboratory investigations including prothrombin time [PT], partial thromboplastin time [PTT], serum albumin, SCOT and SGPT. Protein C activity and total and free protein S were measured in all the cases.PT and PTT were significantly prolonged, but there was only negative correlation between PC activity and PT in all the patients especially of group A There was a positive correlation between PC activity and albumin in all the patients groups. Protein C activity showed a highly significant decrease in the patients' group, particularly group A, when compared to the control [P < 0.01]. Both total and free protein S were reduced in the patients' group but the decrease wasn't statistically significant. Protein S reduction was not as marked as protein C reduction since the former can be synthesized in sites other than the liver. In conclusion Protein C activity and protein S are decreased in chronic liver disease but the decrease of protein C is more pronounced and depends more on the severity of the disease. Thus it is a good marker of liver cell dysfunction and can be used as a prognostic test in chronic liver disease