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Procoagulant imbalance influences cardiovascular and liver damage in chronic hepatitis C independently of steatosis.

Authors
  • Sigon, Giordano1
  • D'Ambrosio, Roberta2
  • Clerici, Mariagrazia3
  • Pisano, Giuseppina1
  • Chantarangkul, Veena3
  • Sollazzi, Roberta1
  • Lombardi, Rosa1
  • Peyvandi, Flora4
  • Lampertico, Pietro2
  • Fargion, Silvia1
  • Tripodi, Armando3
  • Fracanzani, Anna Ludovica1
  • 1 Unit of Medicine and Metabolic Diseases, Pathophysiology and Transplantation Department, Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico, University of Milan, Milan, Italy. , (Italy)
  • 2 Pathophysiology and Transplantation Department, Gastroenterology and Hepatology, CRC AM e A Migliavacca Center for Liver Diseases, Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico, University of Milan, Milan, Italy. , (Italy)
  • 3 IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, Milan, Italy. , (Italy)
  • 4 Department of Pathophysiology and Transplantation, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, Università degli Studi di Milano, Milan, Italy. , (Italy)
Type
Published Article
Journal
Liver international : official journal of the International Association for the Study of the Liver
Publication Date
Dec 01, 2019
Volume
39
Issue
12
Pages
2309–2316
Identifiers
DOI: 10.1111/liv.14213
PMID: 31419372
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Patients with chronic HCV infection besides hepatitis often present cardiovascular damage, the pathogenesis of which is not defined. In chronic liver diseases, including NAFLD and cirrhosis, a procoagulant imbalance, potentially responsible for atherosclerosis has been reported. We aimed at evaluating whether a procoagulant imbalance is present also in non-cirrhotic patients with HCV infection and whether the procoagulant imbalance correlates with cardiovascular damage. The correlation between the procoagulant imbalance, coexisting steatosis, and liver fibrosis was analysed. From 2014 to 2018, 393 subjects (205 patients with chronic HCV infection from two liver units and 188 controls) were enrolled. Metabolic, cardiovascular, liver assessment and coagulation parameters-procoagulants (FII and FVIII) and anticoagulants (antithrombin and protein C [PC]), endogenous thrombin potential (ETP), peak-thrombin and their ratios (with/without thrombomodulin)-were determined. The procoagulant imbalance (defined as high FVIII, FVIII/PC ratio, ETP-ratio and peak-thrombin-ratio (with/without thrombomodulin)) was significantly higher in patients with chronic HCV than controls. Steatosis was detected in 87 patients (42%). No difference in coagulation imbalance, carotid and cardiac parameters and severity of liver fibrosis was observed in patients with or without steatosis, despite the latter had less severe metabolic alterations. The FVIII/PC ratio was independently associated with carotid intima-media thickness (coefficient 0.04, 95% CI 0.002-0.07, P = .04) and liver fibrosis (coefficient 0.64, 95% CI 0.37-0.92, P < .0001). Patients with HCV infection, even in the absence of cirrhosis have a procoagulant-imbalance that possibly plays a role in increasing the risk of cardiovascular disease and progression of fibrosis. © 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

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