The predictive value of admission and follow up factor V and VII levels in patients with acute hepatitis and coagulopathy

Background/Aims

Low factor V and VII levels are bad prognostic indicators in fulminant hepatic failure (FHF). The prognostic importance of admission versus follow up levels of these factors in patients with acute hepatitis and coagulopathy without encephalopathy has not been evaluated.

Methods

Clinical and laboratory data from 68 consecutive patients with acute hepatitis and coagulopathy but without encephalopathy, during a 6-year period, was retrospectively evaluated.

Results

Sixty patients (88%) demonstrated improvement in liver function and coagulation (‘survivors’), while 8 patients (12%) died or underwent OLT (‘non-survivors’). Survivors had higher admission (P<0.005) and follow up factor VII levels (P<0.005) than non-survivors. Follow up factor V levels were higher in survivors (P<0.02), while admission factor V level was not different between groups (P=NS). Multivariate logistic regression analysis demonstrated that admission factor VII levels predicted outcome (P<0.006). Area under the ROC curve of factor VII was larger than that of factor V (0.885 and 0.715, respectively, P<0.02). After 3 days of hospitalization, factor V levels, but not factor VII, independently predicted outcome (P<0.04).

Conclusions

In patients with hepatitis and coagulopathy without encephalopathy at presentation, admission factor VII level may serve as a reliable prognostic marker. Subsequently, during hospitalization, changes in factor V are better outcome indicators.

Keywords: Hepatitis, Coagulation, Factor VII, Factor V

Abbreviations: PTT, partial prothrombin time, PT, prothrombin time, INR, international normalized ratio, AST, aspartate aminotransferase, ALT, alanine aminotransferase