Infection and hemostasis in decompensated cirrhosis: A prospective study using thrombelastography
Open Access
- 1 April 1999
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Hepatology
- Vol. 29 (4), 1085-1090
- https://doi.org/10.1002/hep.510290437
Abstract
Bacterial infections are common complications in decompensated cirrhosis, but their relationship with hemostasis has not been studied. We prospectively assessed whether infection affects hemostasis in cirrhosis using routine hemostasis tests and thrombelastography (TEG), a global test of hemostatic function. Eighty-four cirrhotic patients (Child-Pugh B: 26; C: 58) without overt bleeding or blood-product transfusion were prospectively evaluated with routine hemostasis tests and TEG on admission and/or the first day with signs of infection and 5 days later. There were 30 patients with infection; 15 had infection on admission, and 15 developed infection in hospital. In the patients who developed infection in hospital, there was a significant deterioration in all routine hemostasis tests except platelet count (PLT) and in all TEG parameters, on the first day of infection compared with 7 ± 3 days previously. The same parameters significantly improved from the first day of infection to day 5 and after (P < .02) only in the 22 patients whose infection resolved, while the r, k, and α TEG parameters significantly worsened in the 8 patients with persistent infection. In those who developed infection in hospital and were cured (n = 11), the 5-day parameters did not differ from their preinfection values. In conclusion, bacterial infections frequently impair hemostasis in decompensated cirrhotic patients. Successful treatment of infection usually restores hemostasis parameters to preinfection levels in 5 days. Thus, infection may have a role in the bleeding diathesis of cirrhosisKeywords
This publication has 38 references indexed in Scilit:
- Bacterial infection is independently associated with failure to control bleeding in cirrhotic patients with gastrointestinal hemorrhageHepatology, 1998
- Transfusion based on clinical coagulation monitoring does reduce hemorrhage during liver transplantationLiver Transplantation and Surgery, 1997
- Association between low-grade disseminated intravascular coagulation and endotoxemia in patients with liver cirrhosisGastroenterology, 1995
- Prognostic significance of bacterial infection in bleeding cirrhotic patients: A prospective studyGastroenterology, 1995
- Multiple Organ Failure Syndrome in the 1990sPublished by American Medical Association (AMA) ,1994
- A prospective study of bacterial infections in patients with cirrhosisJournal of Hepatology, 1993
- THROMBELASTOGRAPHYBritish Journal of Anaesthesia, 1992
- Haemostatic problems in liver disease.Gut, 1986
- Oral, nonabsorbable antibiotics prevent infection in cirrhotics with gastrointestinal hemorrhageHepatology, 1985
- Reticuloendothelial System Phagocytic Activity in Cirrhosis and Its Relation to Bacterial Infections and PrognosisHepatology, 1984