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Indian Journal of Gastroenterology

, Volume 38, Issue 2, pp 143–149 | Cite as

Antithrombin as a marker of severe acute hepatitis B

  • Simona ArientováEmail author
  • O. Beran
  • P. Chalupa
  • M. Kořínková
  • M. Holub
Original Article
  • 43 Downloads

Abstract

Background

Acute hepatitis B (AHB) can run a severe course, which sometimes leads to a fulminant disease with acute liver failure (ALF). Pro-coagulation factors are well-established markers of AHB severity, but less is known about the levels of anti-coagulation parameters in AHB.

Methods

In this study, we demonstrate that antithrombin (AT) plasma levels were associated with AHB severity in 161 patients.

Results

Nine (6%) patients had severe AHB (i.e. international normalized ratio [INR] ≥ 1.6 and total bilirubin ≥ 10 mg/dL). Coagulopathy (i.e. INR > 1.2 and/or AT < 80%) was observed in 65 (40%) AHB patients on admission. Low initial plasma AT levels (i.e. < 80%) were observed in 56 (35%) patients. In all, plasma AT levels decreased in 91 (57%) patients during their hospital stay. Both baseline and nadir AT levels were significantly lower in severe than in mild and moderate AHB. Moreover, the concentration of AT negatively correlated with INR, aspartate aminotransferase, and total and conjugated bilirubin levels. Interestingly, nadir AT levels positively correlated with the duration of hospitalization.

Conclusions

These results indicate that plasma AT levels can be used as an additional marker of AHB severity.

Keywords

Acute hepatitis B Antithrombin Coagulopathy Severity 

Notes

Funding information

The study was supported by a project PROGRESS Q26-7 and UNCE 204022.

Compliance with ethical standards

Conflict of interest

SA, OB, PC, MK, and MH declare that they have no conflict of interest.

Ethics statement

The authors declare that the study was performed in a manner conforming to the Helsinki declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on Springer.com.

Disclaimer

The authors are solely responsible for the data and the content of the paper. In no way, the Honorary Editor-in-Chief, Editorial Board Members, or the printer/publishers are responsible for the results/findings and content of this article.

References

  1. 1.
    Choi HJ, Ko SY, Choe WH, et al. Clinical features of acute viral hepatitis B in Korea: a multi-center study. Korean J Hepatol. 2011;17:307–12.Google Scholar
  2. 2.
    Ay P, Torunoglu MA, Com S, et al. Trends of hepatitis B notification rates in Turkey, 1990 to 2012. Euro Surveill. 2013;18:20636.Google Scholar
  3. 3.
    Wilkins T, Zimmerman D, Schade RR. Hepatitis B: diagnosis and treatment. Am Fam Physician. 2010;81:965–72.Google Scholar
  4. 4.
    Hahne S, van Houdt R, Koedijk F, et al. Selective hepatitis B virus vaccination has reduced hepatitis B virus transmission in the Netherlands. PLoS One. 2013;8:e67866.CrossRefGoogle Scholar
  5. 5.
    Thibault V, Laperche S, Thiers V, et al. Molecular epidemiology and clinical characteristics of hepatitis B identified through the French mandatory notification system. PLoS One. 2013;8:e75267.Google Scholar
  6. 6.
    Zheng YB, Huang ZL, Wu ZB, et al. Dynamic changes of clinical features that predict the prognosis of acute-on-chronic hepatitis B liver failure: a retrospective cohort study. Int J Med Sci. 2013;10:1658–64.CrossRefGoogle Scholar
  7. 7.
    Sagnelli E, Sagnelli C, Pisaturo M, Macera M, Coppola N. Epidemiology of acute and chronic hepatitis B and delta over the last 5 decades in Italy. World J. Gastroenterol. 2014;20:7635–43.CrossRefGoogle Scholar
  8. 8.
    Gerada J, Borg E, Formosa D, Magro R, Pocock J. Tenofovir as rescue therapy following clinical failure to lamivudine in severe acute hepatitis B. Mediterr J Hematol Infect Dis. 2013;5:e2013035.CrossRefGoogle Scholar
  9. 9.
    Miyake Y, Iwasaki Y, Takaki A, et al. Lamivudine treatment improves the prognosis of fulminant hepatitis B. Intern Med. 2008;47:1293–9.CrossRefGoogle Scholar
  10. 10.
    De Socio GV, Sgrelli A, Tosti A, Baldelli F. Severe acute hepatitis B treated with entecavir. Mediterr J Hematol Infect Dis. 2011;3:e2011010.CrossRefGoogle Scholar
  11. 11.
    Liang TJ, Hepatitis B. The virus and disease. Hepatology. 2009;495 Suppl:S13–21.Google Scholar
  12. 12.
    Wiegand J, Wedemeyer H, Franke A, et al. Treatment of severe, nonfulminant acute hepatitis B with lamivudine vs placebo: a prospective randomized double-blinded multicentre trial. J Viral Hepat. 2014;21:744–50.CrossRefGoogle Scholar
  13. 13.
    Chalupa P, Holub M. Favorable outcome of severe acute hepatitis B in a patient treated with antithrombin III and antiviral therapy. Clin Infect Dis. 2009;49:481.Google Scholar
  14. 14.
    European Association for the Study of the Liver. EASL. 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection. J Hepatol. 2017;67:370–98.CrossRefGoogle Scholar
  15. 15.
    Mueller MM, Bomke B, Seifried E. Fresh frozen plasma in patients with disseminated intravascular coagulation or in patients with liver diseases. Thromb Res. 2002;107Suppl 1:S9–17.Google Scholar
  16. 16.
    Warren BL, Eid A, Singer P, et al. Caring for the critically ill patient. High-dose antithrombin III in severe sepsis: a randomized controlled trial. JAMA. 2001;286:1869–78.Google Scholar
  17. 17.
    Nakahara K, Okuse C, Adachi S, et al. Use of antithrombin and thrombomodulin in the management of disseminated intravascular coagulation in patients with acute cholangitis. Gut Liver. 2013;7:363–70.Google Scholar
  18. 18.
    Sakamoto Y, Inoue S, Iwamura T, et al. Studies on therapeutic effects and pathological features of an antithrombin preparation in septic disseminated intravascular coagulation patients. Yonsei Med J. 2013;54:686–9.CrossRefGoogle Scholar
  19. 19.
    Hughes RD, Wendon J, Gimson AE. Acute liver failure. Gut. 1991;32Suppl:S86–91.Google Scholar
  20. 20.
    Hoefer J, Ulmer H, Kilo J, et al. Antithrombin III is associated with acute liver failure in patients with end-stage heart failure undergoing mechanical circulatory support. J Thorac Cardiovasc Surg. 2017;153:1374–82.CrossRefGoogle Scholar
  21. 21.
    Pereyra D, Offensperger F, Klinglmueller F, et al. Early prediction of postoperative liver dysfunction and clinical outcome using antithrombin III-activity. PLoS One. 2017;12:e0175359.CrossRefGoogle Scholar
  22. 22.
    Kuroda S, Tashiro H, Kobayashi T, Hashimoto M, Mikuriya Y, Ohdan H. Administration of antithrombin III attenuates posthepatectomy liver failure in hepatocellular carcinoma. Dig Surg. 2015;32:173–80.CrossRefGoogle Scholar
  23. 23.
    Isik S, Tuncyurek P, Zengin NI, et al. Antithrombin prevents apoptosis by regulating inflammation in the liver in a model of cold ischemia/warm reperfusion injury. Hepatogastroenterology. 2012;59:453–7.Google Scholar
  24. 24.
    Afshari A, Wetterslev J, Brok J, Moller A. Antithrombin III in critically ill patients: systematic review with meta-analysis and trial sequential analysis. BMJ. 2007;335:1248–51.Google Scholar
  25. 25.
    Casals-Seoane F, Arberas-Diez B, Garcia-Buey L. Tenofovir treatment of the severe acute hepatitis B. Rev Esp Enferm Dig. 2013;105:57–8.CrossRefGoogle Scholar
  26. 26.
    Tillmann HL, Zachou K, Dalekos GN. Management of severe acute to fulminant hepatitis B: to treat or not to treat or when to treat? Liver Int. 2012;32:544–53.Google Scholar
  27. 27.
    Kumar M, Satapathy S, Monga R, et al. A randomized controlled trial of lamivudine to treat acute hepatitis B. Hepatology. 2007;45:97–101.Google Scholar
  28. 28.
    Price J. An update on hepatitis B, D, and E viruses. Top Antivir Med. 2014;21:157–63.Google Scholar
  29. 29.
    Souza LA, Mattos AA, Fiorini M, Ribeiro P, Tovo CV. Clinical outcome of a patient cohort with acute hepatitis B. Clinics (Sao Paulo). 2013;68:718–20.Google Scholar

Copyright information

© Indian Society of Gastroenterology 2019

Authors and Affiliations

  1. 1.Department of Infectious Diseases, First Faculty of MedicineCharles University and Military University HospitalPragueCzech Republic
  2. 2.Department of Infectious and Tropical Diseases, First Faculty of MedicineCharles University and Na Bulovce HospitalPragueCzech Republic

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