2015, Number 6
<< Back Next >>
Ann Hepatol 2015; 14 (6)
Evaluation the value of markers for prediction of portal vein thrombosis after devascularization
Fei Y, Zong Guang-quan, Chen J, Liu Ren-min
Language: English
References: 23
Page: 856-861
PDF size: 90.47 Kb.
ABSTRACT
Aim. To evaluate the value of D-dimer and P-selectin in cirrhotic portal hypertension (PHT) patients for
prediction of portal vein thrombosis (PVT) after devascularization.
Material and methods. 137 patients with
cirrhotic PHT who undergone devascularization from January 2012 to April 2014 were retrospectively reviewed,
all of them were divided into two groups (PVT group and non-PVT group) by Doppler ultrasonography
(DU) examination. The level of D-dimer and P-selectin was tested during the peri-operative period.
Results. 38 patients (27.7%) were found PVT by DU examination post-operatively. In contrast to the non-
PVT group, the level of D-dimer and P-selectin in the PVT group was much higher significantly at 1, 3 and 7
days after devascularization (P ‹ 0.05). However, in the 15 days after surgery, the difference of P-selectin
between the two groups was not significant (P = 0.260). It was shown that the higher sensitivity of the two
markers for PVT was D-dimer, the higher specificity belonged to P-selectin. The area under receiver operating
characteristic (ROC) curve of P-selectin was the bigger of the two markers. When the two markers
were combined to be used to diagnose PVT, the sensitivity was increased to 0.911, with a slight drop of
specificity to 0.715, the area under ROC curve was 0.919.
Conclusion. The level of D-dimer and P-selectin
might be good candidate predictive markers for PVT in patients with cirrhotic PHT after devascularization.
The combined test of the two markers can increase the value of prediction.
REFERENCES
Winslow ER, Brunt LM, Drebin JA. Portal vein thrombosis after splenectomy. Am J Surg 2002; 184: 631-5.
Webster GJ, Burroughs AK, Riordan SM. Review article: portal vein thrombosis-new insights into aetiology and management. Aliment Pharmacol Ther 2005; 21: 1-9.
de Franchis R. Evolving consensus in portal hypertension. J Hepatol 2005; 43: 167-76.
Grace ND, Groszmann RJ, Garcia-Tsao G, Burroughs AK, Pagliaro L, Makuch RW. Portal hypertension and variceal bleeding: an AASLD single topic symposium. Hepatology 1998; 28: 868-80.
Garcia-Tsao G, Bosch J, Groszmann R. Portal hypertension and variceal bleeding, unresolved issues. Summary of an American Association for the study of liver disease and European Association for the study of the liver single-topic conference. Hepatology 2008; 47: 1764-72.
van der Bom JG, Heckbert SR, Lumley T, Holmes CE, Cushman M, Folsom AR, Rosendaal FR, et al. Platelet count and the risk for thrombosis and death in the elderly. J Thromb Haemost 2009; 7: 399-405.
Gosselin RC, Wu JR, Kottke-Marchant K, Peetz D, Christie DJ, Muth H, Panacek E. Evaluation of the Stratus CS Acute Care D-dimer assay (DDMR) using the Stratus CS STAT Fluorometric Analyzer: a prospective multisite study for exclusion of pulmonary embolism and deep vein thrombosis. Thromb Res 2012; 130: e274-e278.
Patel KN, Soubra SH, Bellera RV, Dong JF, McMullen CA, Burns AR, Rumbaut RE. Differential role of von Willebrand factor and P-selectin on microvascular thrombosis in endotoxemia. Arterioscler Thromb Vasc Biol 2008; 28: 2225-30.
Smith K. Endoscopy: ESD is associated with a moderate risk of deep vein thrombosis that may be determined by Ddimer levels. Nat Rev Gastroenterol Hepatol 2011; 8: 538.
Gremmel T, Ay C, Seidinger D, Pabinger I, Panzer S, Koppensteiner R. Soluble p-selectin, D-dimer, and high-sensitivity C-reactive protein after acute deep vein thrombosis of the lower limb. J Vasc Surg 2011; 54(6 Suppl.): 48S-55S.
Zong GQ, Fei Y, Chen J, Liu RM, Xu YF. Effects of selective double portazygous disconnection and devascularization on hemodynamics of the portal venous system. Med Ultrason 2014; 16: 291-7.
Zong GQ, Fei Y, Chen J, Liu RM. Selective double disconnection for cirrhotic portal hypertension. J Surg Res 2014; 192: 383-9.
Sobhonslidsuk A, Reddy KR. Portal vein thrombosis: a concise review. Am J Gastroenterol 2002; 97: 535-41.
Reit MV, Burger JW, van Muiswinkel JM. Diagnosis and treatment of portal vein thrombosis following splenectomy. Br J Surg 2000; 87: 1229-33.
Lisman T. Low molecular weight heparin in management and prevention of portal vein thrombosis. Thromb Res 2014; 134: 761-2.
Jensen MK, de Nully Brown P, Lund BV, Nielsen OJ, Hasselbalch HC. Increased circulating platelet-leukocyte aggregates in myeloproliferative disorders is correlated to previous thrombosis, platelet activation and platelet count. Eur J Haematol 2001; 66: 143-51.
Martin K, Kia L, Parikh-Neehar D, Kulik L, McMahon B. Heparin-induced thrombocytopenia testing is overutilized in cirrhosis & correlates with poor clinical outcomes. Ann Hepatol 2014; 13: 548-54.
Risch L, Monn A, Lüthy R, Honegger H, Huber AR. The predictive characteristics of D-dimer testing in outpatients with suspected venous thromboembolism: a Bayesian approach. Clin Chim Acta 2004; 345: 79-87.
Palareti G, Cosmi B, Legnani C, Tosetto A, Brusi C, Iorio A, Pengo V, et al. D-dimer testing to determine the duration of anticoagulation therapy. N Engl J Med 2006; 355: 1780-9.
Cosmi B, Legnani C, Tosetto A, Pengo V, Ghirarduzzi A, Testa S, Prisco D, et al. Usefulness of repeated D-dimer testing after stopping anticoagulation for a first episode of unprovoked venous thromboembolism: the PROLONG II prospective study. Blood 2010; 115: 481-8.
Ramacciotti E, Blackburn S, Hawley AE, Vandy F, Ballard- Lipka N, Stabler C, Baker N, et al. Evaluation of soluble Pselectin as a marker for the diagnosis of deep venous thrombosis. Clin Appl Thromb Hemost 2011; 17: 425-31.
Blann AD, Noteboom WM, Rosendaal FR. Increased soluble P-selectin levels following deep venous thrombosis: cause or effect. Br J Haematol 2000; 108: 191-3.
Myers DD, Hawley AE, Farris DM. P-selectin and leukocyte microparticles are associated with venous thrombogenesis. J Vase Surg 2003; 38: 1075-89.