FVIII/PC predicts complication risk in ACLD, but not coagulation potential

In patients with advanced chronic liver disease (ACLD), ratio of procoagulant factor VIII to anticoagulant protein C (FVIII/PC) is significantly prognostic of decompensation, death, and acute-on-chronic liver failure (ACLF), a new study has found. However, FVIII/PC is not related to thrombosis and does not reflect coagulation.

For the analysis of the prognostic value of FVIII/PC, the researchers enrolled 576 patients with evidence of advanced chronic liver disease. They found that FVIII/PC increased significantly with worsening clinical stage (p<0.001), as well as with increasing hepatic venous pressure gradient and model for end-stage liver disease score (p<0.001 for both).

Moreover, FVIII/PC was significantly correlated with decompensation/liver-related death even after multivariable adjustment (adjustment hazard ratio [HR], 1.06, 95 percent confidence interval [CI], 1.01–1.11; p=0.013). A similar effect was reported for the outcome of ACLF (adjusted HR, 1.10, 95 percent CI, 1.02–1.19; p=0.015) in patients with decompensated cirrhosis.

To assess whether FVIII/PC can reflect a hypercoagulable state, the researchers looked at a cohort of 142 patients. They found that while there was an initial weak correlation between FVIII/PC and endogenous thrombin potential (Spearman’s p, 0.255; p=0.002), this association was attenuated after controlling for disease severity. In addition, FVIII/PC was unrelated to bleeding (p=0.272) or thrombotic events (p=0.269).

“A balanced coagulation system is essential for preventing bleeding episodes and blood clot formation. Blood of patients with advanced liver disease may have increased coagulation potential, possibly promoting the worsening of liver disease via thrombosis in the blood vessels of the liver,” the researchers said.

“The ratio between the results of two blood tests—procoagulant factor VIII to anticoagulant protein C—has been suggested to reflect these increases in coagulation potential. Our study demonstrates, on the one hand, that this ratio is a versatile predictor of the development of complications of cirrhosis, yet on the other hand, that it is unrelated to coagulation,” they added.