Predictive value of coagulation test parameters for acute upper gastrointestinal bleeding in patients with liver cirrhosis

Objective To investigate the association between coagulation test parameters and acute upper gastrointestinal bleeding ( AUGIB) in patients with liver cirrhosis. Methods A total of 233 patients with liver cirrhosis who were hospitalized in Department of Gastroenterology, Jiading District Central Hospital, Shanghai University of Medicine & Health Sciences, from January 2013 to December 2016, and according to the presence or absence of AUGIB, they were divided into AUGIB group with 87 patients and non-AUGIB group with 146 patients. Related clinical data were collected, including name, sex, age, cause of liver cirrhosis, ascites, hepatic encephalopathy, blood parameters of the first blood test after admission [routine blood test results, total bilirubin ( TBil) , albumin, and creatinine], coagulation test results [prothrombin time ( PT) , prothrombin time activity ( PTA) , activated partial thromboplastin time ( APTT) , international normalized ratio ( INR) , fibrinogen ( FIB) , thrombin time ( TT) ], and D-dimer. The Child-Pugh score and Model for End-Stage Liver Disease ( MELD) score were calculated based on these data. The independent samples t-test was used for comparison of continuous data between two groups, and an analysis of variance was used for comparison between multiple groups. Logistic regression was used for univariate and multivariate analyses of related variables. Results Compared with the patients with Child-Pugh class A/B liver cirrhosis, the patients with Child-Pugh class C liver cirrhosis had significantly longer PT, APTT, and TT, a significantly higher INR, significant reductions in PTA and FIB, and significant increases in TBil and MELD score ( F = 62. 706, 33. 858, 17. 781, 63. 025, 46. 907, 7. 514, 23. 020, and20. 519, all P < 0. 05) . Of all 233 patients, only 175 underwent the measurement of D-dimer, and D-dimer was not measured for 58 patients, which caused data loss. According to the Child-Pugh class, the 175 patients who underwent D-dimer measurement were divided into Child-Pugh class A group with 33 patients, Child-Pugh class B group with 93 patients, and Child-Pugh class C group with 49 patients, and there was a significant difference in the level of D-dimer between these three groups ( 1. 63 ± 2. 15 mg/L vs 3. 48 ± 4. 25 mg/L vs 4. 24 ± 4. 79 mg/L, F = 4. 089, P = 0. 018) . Compared with the MELD ≥13 group, the MELD < 13 group had significantly longer PT, INR, and APTT and a significant reduction in PTA ( t = 7. 307, 7. 602, 3. 650, and 5. 546, all P < 0. 05) . Among the 87 patients in the AUGIB group, 76 had esophagogastric variceal bleeding, 9 had peptic ulcer, 1 had bleeding due to portal hypertensive gastropathy, and 1 had bleeding due to gastric carcinoma. Compared with the non-AUGIB group, the AUGIB group had a significantly longer APTT, a significantly higher FIB level, and a significantly higher Child-Pugh class ( t = 7. 178, 14. 644, and 30. 082, all P < 0. 05) . APTT and FIB were significantly associated with AUGIB ( APTT: likelihood ratio [LR]= 1. 09, 95% confidence interval [CI]: 1. 04-1. 14, P < 0. 001; FIB:LR = 2. 34, 95% CI: 1. 61-3. 41, P < 0. 001) . Conclusion The increases in PT, INR, and APTT parallel with Child-Pugh class and MELD score in patients with liver cirrhosis, and the prolongation of APTT and the increase in FIB can predict the possibility of AUGIB in patients with liver cirrhosis.