Alternatively spliced tissue factor levels are elevated in the plasma of patients with chronic liver diseases

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Abstract

Objectives

In patients with chronic liver diseases, hypercoagulability can contribute to the progression of fibrosis and complications of cirrhosis. Tissue factor (TF) is a transmembrane glycoprotein that initiates the extrinsic pathway of blood coagulation. Recent investigations have established that TF is elevated in patients with pancreatic cancer, blood disorders, diabetes, and cardiovascular disease. Alternatively spliced tissue factor (asTF), a secreted form of TF, induces angiogenesis and exhibits low-level procoagulant activity. The aim of this study was to investigate whether the circulating levels of asTF are elevated in the plasma of patients with liver disease.

Materials and methods

In a single-center study, we retrospectively analyzed asTF plasma levels in healthy participants and patients having stage F0–F3 liver fibrosis, liver cirrhosis, as well as hepatocellular carcinoma (HCC). AsTF plasma levels were measured using a sandwich enzyme-linked immunosorbent assay. Values were expressed as median with interquartile range (IQR).

Results

The lowest median plasma asTF concentration (94 pg/ml, IQR: 33–275) was found in the healthy control group. The patients with low-grade liver fibrosis (F0–F1 group) displayed the highest median asTF concentration (404 pg/ml, IQR: 277–789). Significant differences between the asTF levels in the plasma of healthy participants and those in patients with grade F0–F1 fibrosis (P<0.001), patients with grade F2–F3 fibrosis (P=0.019), patients with cirrhosis (P=0.004), and patients with HCC (P<0.001) were found using a Wilcoxon rank-sum test. Treatment-naive patients with HCC had significantly higher asTF levels (P=0.018) than those receiving treatment. AsTF levels were found to increase with worsening Child–Pugh scores and heightened liver disease activity.

Conclusion

AsTF levels are elevated in patients with chronic liver diseases, which increase with worsening Child–Pugh scores and decrease following HCC therapy.

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